Provider Demographics
NPI:1265772263
Name:VITTAL CHUNDRU MD PA
Entity type:Organization
Organization Name:VITTAL CHUNDRU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VITTAL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHUNDRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-362-4877
Mailing Address - Street 1:11912 SOUTHERN TRAILS CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4563
Mailing Address - Country:US
Mailing Address - Phone:352-362-4877
Mailing Address - Fax:352-854-4399
Practice Address - Street 1:11912 SOUTHERN TRAILS CT
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4563
Practice Address - Country:US
Practice Address - Phone:352-362-4877
Practice Address - Fax:352-854-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3304282E00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No282E00000XHospitalsLong Term Care Hospital