Healthcare Provider Details

I. General information

NPI: 1891775425
Provider Name (Legal Business Name): RUDRAMA DUGGIRALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 45 PITKIN AVE
OZONE PARK NY
11417
US

IV. Provider business mailing address

15726 16TH RD
WHITESTONE NY
11357-3226
US

V. Phone/Fax

Practice location:
  • Phone: 347-454-9152
  • Fax: 347-454-9153
Mailing address:
  • Phone: 917-304-7025
  • Fax: 718-322-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number187905
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: