Healthcare Provider Details

I. General information

NPI: 1225089402
Provider Name (Legal Business Name): SUNIL DOGRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6216 FAYETTEVILLE RD SUITE 104
DURHAM NC
27713-6287
US

IV. Provider business mailing address

6216 FAYETTEVILLE RD STE 104
DURHAM NC
27713-6287
US

V. Phone/Fax

Practice location:
  • Phone: 919-806-1333
  • Fax: 919-806-1335
Mailing address:
  • Phone: 919-866-1333
  • Fax: 919-806-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number9400473
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number9400473
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number9400473
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9400473
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: