Dwaraki Bai Penugonda, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD035084Y Issued in PA

Practice address

166 Hanover St
Suite 307
Wilkes Barre, PA 18702-3549

Phone

(570) 823-8184

Fax

(570) 823-6460

NPI assigned

Jan 2, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dwaraki Bai Penugonda MD PC

  • Specialist
  • Wilkes Barre, PA
  • NPI 1588866792
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386701357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 HANOVER ST",
            "address_2": "SUITE 307",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187023549",
            "telephone_number": "570-823-8184",
            "fax_number": "570-823-6460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 HANOVER ST",
            "address_2": "SUITE 307",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187023549",
            "telephone_number": "570-823-8184",
            "fax_number": "570-823-6460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENUGONDA",
        "first_name": "DWARAKI",
        "middle_name": "BAI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD035084Y",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006538020001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jeffrey David Perluke, MD
• Jennifer Boberg Perry, PSY.D.

• Pediatrics Physician in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.