Individual
DR. DWARAKI BAI PENUGONDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
166 HANOVER ST, SUITE 307, WILKES BARRE, PA 18702-3549
(570) 823-8184
(570) 823-6460
Mailing address
166 HANOVER ST, SUITE 307, WILKES BARRE, PA 18702-3549
(570) 823-8184
(570) 823-6460
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD035084Y
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006538020001
—
PA
Enumeration date
01/02/2007
Last updated
07/08/2007
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