Organization
DWARAKI BAI PENUGONDA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DWARAKI BAI PENUGONDA MD (PHYSICIAN)
(570) 823-8184
Entity
Organization
Contact information
Practice address
166 HANOVER ST, WILKES BARRE, PA 18702-3549
(570) 823-8184
(570) 823-6460
Mailing address
166 HANOVER ST, WILKES BARRE, PA 18702-3549
(570) 823-8184
(570) 823-6460
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD035084Y
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006538020001
—
PA
Enumeration date
06/01/2007
Last updated
08/22/2020
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