Healthcare Provider Details

I. General information

NPI: 1659529147
Provider Name (Legal Business Name): JYOTHI CHOWDARY NANNAPANENI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL STE 308
RALEIGH NC
27607-7514
US

IV. Provider business mailing address

4414 LAKE BOONE TRL STE 308
RALEIGH NC
27607-7514
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-7450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number259947
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: