Healthcare Provider Details

I. General information

NPI: 1205521481
Provider Name (Legal Business Name): ASTHA SHREE KRISHNA POUDEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-2078
  • Fax: 317-968-1055
Mailing address:
  • Phone: 317-944-2078
  • Fax: 317-968-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number01100868A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: