Provider Demographics
NPI:1447520200
Name:SUBENDRA-KONINI, LOGITHYA (MD)
Entity type:Individual
Prefix:
First Name:LOGITHYA
Middle Name:
Last Name:SUBENDRA-KONINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOGITHYA
Other - Middle Name:
Other - Last Name:SUBENDRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7373 WEST LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3377
Mailing Address - Country:US
Mailing Address - Phone:209-476-2000
Mailing Address - Fax:
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-685-2900
Practice Address - Fax:908-704-3764
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program