Healthcare Provider Details

I. General information

NPI: 1689179822
Provider Name (Legal Business Name): DHURBA PRASAD DHUNGANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 SOMERSET BLVD STE 101
CHARLES TOWN WV
25414-3954
US

IV. Provider business mailing address

154 HOSPITAL DR STE 4
TYRONE PA
16686-1829
US

V. Phone/Fax

Practice location:
  • Phone: 304-725-2663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME149222
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD478645
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number33552
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: