MEDICARE: POONAM RAUNIYAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD00048601	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD00048601	OTHER	WA	STATE LICENSE

General Provider Information

NPI Number	:	1366602468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POONAM RAUNIYAR MD

Provider Business Mailing Address
First Line	:	PO BOX 3360
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3360
Country	:	US
Telephone Number	:	866-366-2983
Fax Number	:

Provider Business Practice Location Address
First Line	:	4112 HARBOUR POINTE BLVD SW
Second Line	:	STE 100
City	:	MUKILTEO
State	:	WA
Zip	:	98275-5457
Country	:	US
Telephone Number	:	425-347-6330
Fax Number	:	425-347-6335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	05/18/2021

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Directions to “ POONAM RAUNIYAR MD” Practice Location

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