Provider Demographics
NPI:1922100981
Name:DUGGAL, MAHESH K (MD)
Entity Type:Individual
Prefix:
First Name:MAHESH
Middle Name:K
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 1:319 PENNY LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1221
Mailing Address - Country:US
Mailing Address - Phone:704-403-7780
Mailing Address - Fax:704-403-7781
Practice Address - Street 1:319 PENNY LN
Practice Address - Street 2:SUITE B
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1221
Practice Address - Country:US
Practice Address - Phone:704-403-7780
Practice Address - Fax:704-403-7781
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050513207R00000X, 207RG0300X
NC2008-01508207RG0300X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000941564DMedicaid
NC5910503Medicaid
NC1922100981Medicaid
SCG50513Medicaid
H55275Medicare UPIN
NCNCE890AMedicare PIN
SCG50513Medicaid
GA11BDWVZMedicare PIN
NC5910503Medicaid