Healthcare Provider Details

I. General information

NPI: 1518148014
Provider Name (Legal Business Name): MARUTHI PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number9800844
License Number StateNC

VIII. Authorized Official

Name: DR. BADRPRASAD R DONTHI
Title or Position: PRESIDENT
Credential: MD
Phone: 919-462-6206