Provider Demographics
NPI:1902470305
Name:KOMMANA, ABHAY (DO)
Entity type:Individual
Prefix:
First Name:ABHAY
Middle Name:
Last Name:KOMMANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1918 RANDOLPH RD STE 275
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1109
Practice Address - Country:US
Practice Address - Phone:704-384-1360
Practice Address - Fax:704-316-8735
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151014994207Q00000X
NC2024-02345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine