# POOLESVILLE FAMILY PRACTICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790953065
- **Authorized official:** DR. AMAR VENKAT DUGGIRALA D.O. (FAMILY PHYSICIAN)
- **Authorized official phone:** (301) 972-7600

## Contact information

- **Practice address:** 19710 FISHER AVE, SUITE J, POOLESVILLE, MD 20837-0108
- **Practice address phone:** (301) 972-7600
- **Practice address fax:** (301) 972-8006
- **Mailing address:** 19710 FISHER AVE, SUITE J, PO BOX 108, POOLESVILLE, MD 20837-2098
- **Mailing address phone:** (301) 972-7600
- **Mailing address fax:** (301) 972-8006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | H61505 | MD | Yes |

## Other

- **Enumeration date:** 02/20/2008
- **Last updated:** 02/20/2008