Healthcare Provider Details

I. General information

NPI: 1619945953
Provider Name (Legal Business Name): VENKATASOMAIAH CHOUDARY MOTAPARTHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9458
US

IV. Provider business mailing address

2705 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9458
US

V. Phone/Fax

Practice location:
  • Phone: 919-731-2526
  • Fax: 919-580-0988
Mailing address:
  • Phone: 919-731-2526
  • Fax: 919-580-0988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25379
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: