Individual
DR. MOHAMMED G KIDDUGAVU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5415 OLD COURT RD 101, RANDALLSTOWN, MD 21133-5172
(410) 719-0020
(410) 744-6755
Mailing address
PO BOX 4784, BALTIMORE, MD 21211-0784
(410) 922-2650
(410) 922-1612
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0070832
MD
207RI0200X
Infectious Disease Physician
D0070832
MD
Other
Enumeration date
02/20/2007
Last updated
07/09/2021
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