Healthcare Provider Details

I. General information

NPI: 1871553503
Provider Name (Legal Business Name): BADRIPRASAD R DONTHI M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LATTNER CT STE 100
MORRISVILLE NC
27560-7886
US

IV. Provider business mailing address

110 LATTNER CT STE 100
MORRISVILLE NC
27560-7886
US

V. Phone/Fax

Practice location:
  • Phone: 919-462-6206
  • Fax: 919-462-6207
Mailing address:
  • Phone: 919-462-6206
  • Fax: 919-462-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9800844
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9800084
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: