Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD033967-L | PA |
NPI | 1073514618 |
---|---|
Provider Name | Haragopal K Penugonda |
First Address | Wilkes-Barre, PA 18702 |
Second Address | Wilkes-Barre, PA 18702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0668609 | (05) | PA |
B37137 | (02) |