MEDICARE: SEETARAMAYYA NAGULA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	D0020310	MD

General Provider Information

NPI Number	:	1114926284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEETARAMAYYA NAGULA M.D.

Provider Business Mailing Address
First Line	:	12070 OLD LINE CTR
Second Line	:	SUITE 200
City	:	WALDORF
State	:	MD
Zip	:	20602-2503
Country	:	US
Telephone Number	:	301-645-8035
Fax Number	:	301-645-5229

Provider Business Practice Location Address
First Line	:	12070 OLD LINE CTR
Second Line	:	SUITE 200
City	:	WALDORF
State	:	MD
Zip	:	20602-2503
Country	:	US
Telephone Number	:	301-645-8035
Fax Number	:	301-645-5229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	12/13/2007

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