Provider Demographics
NPI:1003073784
Name:KUDAKANDIRA, JYOTHI B (MD)
Entity type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:B
Last Name:KUDAKANDIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S 21ST ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3851
Mailing Address - Country:US
Mailing Address - Phone:610-618-6761
Mailing Address - Fax:
Practice Address - Street 1:250 S 21ST ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3851
Practice Address - Country:US
Practice Address - Phone:484-526-6643
Practice Address - Fax:833-616-5210
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3751918000OtherINDEPENDENCE BCBS
KU2137735OtherHIGHMARK BCBS
PA089603Medicare PIN