Basic Information
| Provider Information | |||||||||
| NPI: | 1821354176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KONDABOLU | ||||||||
| FirstName: | SIRISH | ||||||||
| MiddleName: | KUMAR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 912 RUSSELL DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172727971 | ||||||||
| FaxNumber: | 7172721241 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2012 | ||||||||
| LastUpdateDate: | 01/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 275452 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD465257 | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.