Healthcare Provider Details

I. General information

NPI: 1437335973
Provider Name (Legal Business Name): PRAVEEN DUGGAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 JUMPERS HOLE RD SUITE 304
SEVERNA PARK MD
21146-1600
US

IV. Provider business mailing address

275 FAIRTREE PLZ
SEVERNA PARK MD
21146-3113
US

V. Phone/Fax

Practice location:
  • Phone: 410-544-9988
  • Fax: 410-544-9994
Mailing address:
  • Phone: 410-544-9988
  • Fax: 410-544-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD79215
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD79215
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: