Healthcare Provider Details

I. General information

NPI: 1992708044
Provider Name (Legal Business Name): PROMOD K DUGGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 GREENWAY CENTER DR SUITE 930
GREENBELT MD
20770-3502
US

IV. Provider business mailing address

7500 GREENWAY CENTER DR SUITE 930
GREENBELT MD
20770-3502
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-2412
  • Fax: 301-345-3978
Mailing address:
  • Phone: 301-345-2412
  • Fax: 301-345-3978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD33942
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: