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General NPI Number Information
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NPI Number | 1588866792
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Entity Type | Organization
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Legal Business Name | DWARAKI BAI PENUGONDA MD PC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 166 HANOVER ST
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City | WILKES BARRE
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State | PA
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Zip | 18702-3549
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Country | US
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Telephone | 570-823-8184
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Fax | 570-823-6460
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Provider Business Mailing Address
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Address Line | 166 HANOVER ST
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City | WILKES BARRE
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State | PA
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Zip | 18702-3549
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Country | US
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Telephone | 570-823-8184
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Fax | 570-823-6460
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DWARAKI BAI PENUGONDA
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Credential | MD
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Telephone | 570-823-8184
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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 | MD035084Y
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License Number State | PA
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