Provider Demographics
NPI:1306137435
Name:PUNDLA, KALYAN K (MD)
Entity type:Individual
Prefix:
First Name:KALYAN
Middle Name:K
Last Name:PUNDLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:HHC CVO ENROLLMENT 1ST FLOOR
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-6970
Mailing Address - Fax:
Practice Address - Street 1:100 HAZARD AVE STE 101
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5447
Practice Address - Country:US
Practice Address - Phone:860-696-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2020-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA258256207R00000X, 208M00000X
CT65199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT65199OtherCT LIC