Provider Demographics
NPI:1386820413
Name:DANDAMUDI, PRAVEEN (MD)
Entity type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:
Last Name:DANDAMUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 MURPHY AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1895
Mailing Address - Country:US
Mailing Address - Phone:615-628-8064
Mailing Address - Fax:
Practice Address - Street 1:2201 MURPHY AVE STE 303
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1895
Practice Address - Country:US
Practice Address - Phone:615-628-8064
Practice Address - Fax:877-297-3060
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125049524207R00000X
TN52782207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6046839OtherBCBS
TNQ013761Medicaid
KY7100358320Medicaid