Provider Demographics
NPI:1437335973
Name:DUGGAL, PRAVEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:
Last Name:DUGGAL
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 1:275 FAIRTREE PLZ
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3113
Mailing Address - Country:US
Mailing Address - Phone:410-544-9988
Mailing Address - Fax:410-544-9994
Practice Address - Street 1:479 JUMPERS HOLE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-1600
Practice Address - Country:US
Practice Address - Phone:410-544-9988
Practice Address - Fax:410-544-9994
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67887207Y00000X
MDD79215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD79215OtherMARYLAND LICENSE
MD418629ZN7BMedicare UPIN