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General NPI Number Information
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NPI Number | 1215250535
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Entity Type | Organization
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Legal Business Name | SUMA & DURGA PA
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 2243 NORTH BLVD W
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City | DAVENPORT
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State | FL
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Zip | 33837-8990
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Country | US
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Telephone | 863-353-1394
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Fax | 863-638-5722
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Provider Business Mailing Address
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Address Line | 4693 MANDOLIN LOOP
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City | WINTER HAVEN
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State | FL
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Zip | 33884-3599
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Country | US
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Telephone | 863-353-1394
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Fax | 863-638-5722
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DURGA MAGANTI
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Credential | MD
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Telephone | 863-968-3634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME 96502
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License Number State | FL
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