Provider Demographics
NPI:1073514618
Name:PENUGONDA, HARAGOPAL K (MD)
Entity Type:Individual
Prefix:
First Name:HARAGOPAL
Middle Name:K
Last Name:PENUGONDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUITE 240 MEDICAL ARTS BLDG
Mailing Address - Street 2:35 W LINDEN STREET
Mailing Address - City:WILKES-BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702
Mailing Address - Country:US
Mailing Address - Phone:570-826-1111
Mailing Address - Fax:570-829-0300
Practice Address - Street 1:SUITE 240 MEDICAL ARTS BLDG
Practice Address - Street 2:35 W LINDEN STREET
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-826-1111
Practice Address - Fax:570-829-0300
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD033967-L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0668609Medicaid
PA0668609Medicaid
B37137Medicare UPIN