Healthcare Provider Details

I. General information

NPI: 1144726050
Provider Name (Legal Business Name): PRIYADURGA KODI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST STE 203
TOWSON MD
21204-5805
US

IV. Provider business mailing address

725 HORSEPOND RD
DOVER DE
19901-7232
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-3760
  • Fax: 443-849-8138
Mailing address:
  • Phone: 302-741-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC1-002636
License Number StateDE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: