NPIMap

Organization Active NPI

Dwaraki Bai Penugonda MD PC

  • Specialist
  • Wilkes Barre, PA
National Provider Identifier
1588866792
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD035084Y Issued in PA
Legal business name
DWARAKI BAI PENUGONDA MD PC
Practice address
166 Hanover St
Wilkes Barre, PA 18702-3549
Phone
(570) 823-8184
Fax
(570) 823-6460
NPI assigned
Jun 1, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Dwaraki Bai Penugonda, MDNPI 1386701357
Title
Physician
Phone
(570) 823-8184

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X MD035084Y PA Primary

Addresses

Primary practice location

166 Hanover St
Wilkes Barre, PA 18702-3549

Mailing address

166 Hanover St
Wilkes Barre, PA 18702-3549
Phone (570) 823-8184

Other identifiers 1

IdentifierTypeStateIssuer
0006538020001MedicaidPA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1588866792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 HANOVER ST",
            "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",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187023549",
            "telephone_number": "570-823-8184",
            "fax_number": "570-823-6460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DWARAKI BAI PENUGONDA MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PENUGONDA",
        "authorized_official_first_name": "DWARAKI",
        "authorized_official_middle_name": "BAI",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "570-823-8184",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD035084Y",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006538020001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.