Provider Demographics
NPI:1891775425
Name:DUGGIRALA, RUDRAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDRAMA
Middle Name:
Last Name:DUGGIRALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15726 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:347-454-9152
Practice Address - Fax:347-454-9153
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187905173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01536456Medicaid
NY01536456Medicaid
NYY32356Medicare UPIN