Healthcare Provider Details

I. General information

NPI: 1245859909
Provider Name (Legal Business Name): NIVEDITA POOLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE # 7319
SAN FRANCISCO CA
94143-2206
US

IV. Provider business mailing address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1595
  • Fax:
Mailing address:
  • Phone: 718-270-6315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA194558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: