Healthcare Provider Details

I. General information

NPI: 1366070963
Provider Name (Legal Business Name): RAJAT DUGGIRALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MESSIMER DR
NEWARK OH
43055-3627
US

IV. Provider business mailing address

200 MESSIMER DR
NEWARK OH
43055-3627
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4870
  • Fax: 220-564-4871
Mailing address:
  • Phone: 220-564-4870
  • Fax: 220-564-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1020427
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number35.157038
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number1020427
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.157038
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: