Individual
DR. MRINALINI SUJALA KODUMAGULLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1831 LAKE PINE DR STE 200, CARY, NC 27511-6050
(919) 380-1849
(919) 380-1851
Mailing address
1831 LAKE PINE DR STE 200, CARY, NC 27511-6050
(919) 380-1849
(919) 380-1851
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200801499
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02DWB
BCBS OF NC
NC
05
—
5910366
—
NC
Enumeration date
08/26/2008
Last updated
09/30/2019
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