Provider Demographics
NPI:1730315482
Name:BOGGALA, VIJAYA PRAKASH (M,D)
Entity Type:Individual
Prefix:
First Name:VIJAYA PRAKASH
Middle Name:
Last Name:BOGGALA
Suffix:
Gender:M
Credentials:M,D
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Other - Middle Name:
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Mailing Address - Street 1:2511 OLD CORNWALLIS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1869
Mailing Address - Country:US
Mailing Address - Phone:919-932-5700
Mailing Address - Fax:919-933-6881
Practice Address - Street 1:2511 OLD CORNWALLIS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1869
Practice Address - Country:US
Practice Address - Phone:919-932-5700
Practice Address - Fax:919-933-6881
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2016-04-19
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Provider Licenses
StateLicense IDTaxonomies
NC2015-02298207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice