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General NPI Number Information
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NPI Number | 1790953065
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Entity Type | Organization
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Legal Business Name | POOLESVILLE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 19710 FISHER AVE SUITE J
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City | POOLESVILLE
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State | MD
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Zip | 20837-0108
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Country | US
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Telephone | 301-972-7600
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Fax | 301-972-8006
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Provider Business Mailing Address
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Address Line | 19710 FISHER AVE SUITE J, PO BOX 108
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City | POOLESVILLE
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State | MD
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Zip | 20837-2098
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Country | US
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Telephone | 301-972-7600
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Fax | 301-972-8006
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Authorized Official
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Title or Position | FAMILY PHYSICIAN
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Name | DR. AMAR VENKAT DUGGIRALA
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Credential | D.O.
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Telephone | 301-972-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H61505
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License Number State | MD
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