Doctor Registration
Basic Information
Prefix / Title*
First Name*
Middle Name
Last Name
Photograph
(only JPG, GIF, PNG images with max size: 2 MB allowed)
Gender
Male Female Other
Date of Birth *
Category*
Government/Public Private Both
Post/ Designation*
Discipline*
  • Allopathy Dental Ayurveda Yoga Naturopathy Unani Siddha Homeopathy Sowa- Rigpa Others
Registration With *
  • Medical Council of India (MCI) Dental Council of India (DCI) Central Council of Indian Medicine Central Council of Homeopathy (CCH) State Medical Councils/Boards Other
For Office Use Only (This information will not be shared publicly)
 
State Council Central Council Both
Registration Number *
 
Hospital/ Medical College / Private Clinic / Others
Name of the Principal place of Practice *
Address *
State *
District *
Sub District
Town
Village
Pin Code *
Telephone *
Mobile *
  • 0
Fax No
  • (eg: STD-Fax No.)
Email ID
Details
  • OPD
  • Timings
  • Days
 
  • IPD
  • Timings
  • Days
 
  • Others
  • Timings
  • Days
Services Available with Clinic
Upload Clinic Photos (Maximum 10 MB)
Google Map Co-ordinates
  • (Latitude, Example 28.568138, Longitude, Example 77.208428)
Associated with Medical Association
Website
Achievement
Name of the Principal place of Practice *
Address *
State *
District *
Sub District
Town
Village
Pin Code *
Telephone *
Mobile *
  • 0
Fax No
  • (eg: STD-Fax No.)
Email ID
Details
  • OPD
  • Timings
  • Days
 
  • IPD
  • Timings
  • Days
 
  • Others
  • Timings
  • Days
Services Available with Clinic
Upload Clinic Photos (Maximum 10 MB) *
Google Map Coordinates
Associated with Medical Association
Website
Achievement
Name of the Principal place of Practice *
Address *
State *
District *
Sub District
Town
Village
Pin Code *
Telephone *
Mobile *
  • 0
Fax No
  • (eg: STD-Fax No.)
Email ID
Details
  • OPD
  • Timings
  • Days
 
  • IPD
  • Timings
  • Days
 
  • Others
  • Timings
  • Days
Services Available with Clinic
Upload Clinic Photos (Maximum 10 MB) *
Google Map Coordinates
Associated with Medical Association
Website
Achievement
Name of the Principal place of Practice *
Address *
State *
District
Sub District
Town
Village
Pin Code *
Telephone *
Mobile *
  • 0
Fax No
  • (eg: STD-Fax No.)
Email ID
Details
  • OPD
  • Timings
  • Days
 
  • IPD
  • Timings
  • Days
 
  • Others
  • Timings
  • Days
Services Available with Clinic
Upload Clinic Photos (Maximum 10 MB) *
Google Map Coordinates
Associated with Medical Association
Website
Achievement
Name of the Principal place of Practice *
Address *
State *
District *
Sub District
Town
Village
Pin Code *
Telephone *
Mobile *
  • 0
Fax No
  • (eg: STD-Fax No.)
Email ID
Details
  • OPD
  • Timings
  • Days
 
  • IPD
  • Timings
  • Days
 
  • Others
  • Timings
  • Days
Services Available with Clinic
Upload Clinic Photos (Maximum 10 MB) *
Google Map Coordinates
Associated with Medical Association
Website
Achievement
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