MEDICARE: DR. BEHDOD POUSHANCHI M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program		WV
2	207RG0100X	Gastroenterology Physician	ME156323	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437507886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEHDOD POUSHANCHI M.D.

Provider Business Mailing Address
First Line	:	7300 SANDLAKE COMMONS BLVD STE 127
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8011
Country	:	US
Telephone Number	:	321-843-4344
Fax Number	:	321-842-4784

Provider Business Practice Location Address
First Line	:	7300 SANDLAKE COMMONS BLVD STE 127
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-8011
Country	:	US
Telephone Number	:	321-843-4344
Fax Number	:	321-842-4784

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

Provider Enumeration Date	:	05/26/2016
Last Update Date	:	10/10/2022

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