Healthcare Provider Details

I. General information

NPI: 1083026561
Provider Name (Legal Business Name): PRIYANKA ANNIGERI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST PHIPPS BLDG, B-100
BALTIMORE MD
21287-4818
US

IV. Provider business mailing address

600 N WOLFE ST PHIPPS BLDG, B-100
BALTIMORE MD
21287-4818
US

V. Phone/Fax

Practice location:
  • Phone: 248-982-8722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301104924
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301104924
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: