Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 01040096 | IN |
NPI | 1285601278 |
---|---|
Provider Name | Dr. Nagarjuna R Ponugoti |
First Address | Terre Haute, IN 47802-4559 |
Second Address | Terre Haute, IN 47802-4559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 08/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100252770A | (05) | IN |
F27507 | (02) |