Healthcare Provider Details

I. General information

NPI: 1932467792
Provider Name (Legal Business Name): TEJA POOSARLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 05/21/2025
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 ELISHA AVENUE
ZION IL
60099
US

IV. Provider business mailing address

2361 PAYSPHERE CIRCLE
CHICAGO IL
60067
US

V. Phone/Fax

Practice location:
  • Phone: 800-322-9183
  • Fax: 571-472-1294
Mailing address:
  • Phone: 800-322-9183
  • Fax: 571-423-5698

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101273767
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23858
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD.37162
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0101273767
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number036.171938
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: