Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | ME113831 | FL |
NPI | 1538321823 |
---|---|
Provider Name | Dr. Madhuri Penugonda |
First Address | Pensacola, FL 32513-2699 |
Second Address | Pensacola, FL 32504-8785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 03/05/2019 |