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General NPI Number Information
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NPI Number | 1093341059
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Entity Type | Individual
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Provider Name | TARAKARAMA DUTT MUSUNURI DO
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Gender | Male
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 01/01/2024
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-5270
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Country | US
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Telephone | 510-676-3031
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Fax |
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Provider Business Mailing Address
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Address Line | 43187 GALLEGOS AVE APT A
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City | FREMONT
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State | CA
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Zip | 94539-5270
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Country | US
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Telephone | 510-676-3031
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0102206974
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OP61460517
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License Number State | WA
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