| Doctor Name: | VIJAYA PRAKASH BOGGALA |
| NPI Number: | 1730315482 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.,D |
| License Number: | 2015-02298 |
| Business Practice Address: | 2511 Old Cornwallis Rd Suite 200 Durham, NC - 277131869 |
| Business Phone Number: | 9199325700 |
| Business Fax Number: | 9199336881 |
| Mailing Address: | 2511 Old Cornwallis Rd, Suite 200 DURHAM |
| State: | NC |
| Postal Code: | 277131869 |
| Phone Number: | 9199325700 |
| Fax Number: | 9199336881 |
| NPI Enumeration Date: | 06/09/2009 |
| NPI Last Update Date: | 04/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 2015-02298 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |