Healthcare Provider Details

I. General information

NPI: 1982929253
Provider Name (Legal Business Name): PREETHI DURGAM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SCHOOL ST STE 20
TOMBALL TX
77375-4597
US

IV. Provider business mailing address

455 SCHOOL ST STE 20
TOMBALL TX
77375-4597
US

V. Phone/Fax

Practice location:
  • Phone: 281-357-5678
  • Fax: 281-357-8765
Mailing address:
  • Phone: 281-357-5678
  • Fax: 281-357-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberQ5395
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberQ5395
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: