Provider Demographics
NPI:1922441344
Name:SITA DUGGIRALA MD PA
Entity Type:Organization
Organization Name:SITA DUGGIRALA MD PA
Other - Org Name:WATERS PEDIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SITA
Authorized Official - Middle Name:LAKSHMI
Authorized Official - Last Name:DUGGIRALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-887-1010
Mailing Address - Street 1:7730 W WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1813
Mailing Address - Country:US
Mailing Address - Phone:813-887-1010
Mailing Address - Fax:813-887-1021
Practice Address - Street 1:7730 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1813
Practice Address - Country:US
Practice Address - Phone:813-887-1010
Practice Address - Fax:813-887-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276288900Medicaid
FL11638012OtherCAQH