Healthcare Provider Details

I. General information

NPI: 1649262445
Provider Name (Legal Business Name): R PRASAD DEGALA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W BECKER DR P.O DRAWER 1520
ROANOKE RAPIDS NC
27870-4800
US

IV. Provider business mailing address

105 W BECKER DR
ROANOKE RAPIDS NC
27870-4800
US

V. Phone/Fax

Practice location:
  • Phone: 252-535-2422
  • Fax: 252-535-1523
Mailing address:
  • Phone: 252-535-2422
  • Fax: 252-535-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30799
License Number StateNC

VIII. Authorized Official

Name: DR. RAMAMOHANA PRASAD DEGALA
Title or Position: PRESIDENT
Credential: MD
Phone: 252-535-2422