Provider Demographics
NPI:1518148014
Name:MARUTHI PEDIATRICS PLLC
Entity Type:Organization
Organization Name:MARUTHI PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BADRPRASAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:DONTHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-462-6206
Mailing Address - Street 1:110 LATTNER CT STE 100
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7886
Mailing Address - Country:US
Mailing Address - Phone:919-462-6206
Mailing Address - Fax:919-462-6207
Practice Address - Street 1:110 LATTNER CT STE 100
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-7886
Practice Address - Country:US
Practice Address - Phone:919-462-6206
Practice Address - Fax:919-462-6207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800844261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908625Medicaid
NC891168FMedicaid