Healthcare Provider Details

I. General information

NPI: 1114128261
Provider Name (Legal Business Name): ANURADHA TUNUGUNTLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
LEWISBURG PA
17837-9350
US

IV. Provider business mailing address

3 WINDY DR
SHAVERTOWN PA
18708-9328
US

V. Phone/Fax

Practice location:
  • Phone: 570-522-5056
  • Fax: 570-524-5061
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD440592
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number9295A
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD440592
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: