Basic Information
| Provider Information | |||||||||
| NPI: | 1023202611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANDULA | ||||||||
| FirstName: | VINAY | ||||||||
| MiddleName: | VARDHAN REDDY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MBBS,FRCR, MRCP, DCH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3964 GATEWAY DR | ||||||||
| Address2: | APARTMENT A1 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191456002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022528288 | ||||||||
| FaxNumber: | 3026514476 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 ROCKLAND RD | ||||||||
| Address2: | DEPARTMENT OF RADIOLOGY, A.I DUPONT CHILDREN'S HOSPITAL | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198033607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026514664 | ||||||||
| FaxNumber: | 3026514476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 01/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085P0229X | C7-0003672 | DE | Y | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085P0229X | MD433905 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085P0229X | C1-0008916 | DE | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085P0229X | MT192173 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
No ID Information.