Provider Demographics
NPI:1518947142
Name:DR. RUDRAMA DUGGIRALA MEDICAL SERVICES,PC
Entity Type:Organization
Organization Name:DR. RUDRAMA DUGGIRALA MEDICAL SERVICES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDRAMA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUGGIRALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-304-7025
Mailing Address - Street 1:15726 16TH RD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3226
Mailing Address - Country:US
Mailing Address - Phone:917-304-7025
Mailing Address - Fax:718-322-2259
Practice Address - Street 1:90 45 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417
Practice Address - Country:US
Practice Address - Phone:718-843-7551
Practice Address - Fax:718-322-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187905173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01536456Medicaid
NY07034Medicare PIN
NY01536456Medicaid