Organization
PARK GASTROENTEROLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALLISITARAM PRASAD KODALI M.D. (OWNER)
(919) 650-6461
Entity
Organization
Contact information
Practice address
7560 CARPENTER FIRE STATION RD STE 303, CARY, NC 27519-9637
(919) 650-6461
Mailing address
7560 CARPENTER FIRE STATION RD STE 303, CARY, NC 27519-9637
(919) 650-6461
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Enumeration date
12/24/2019
Last updated
12/24/2019
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