Healthcare Provider Details

I. General information

NPI: 1982803508
Provider Name (Legal Business Name): KIRAN POUDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KIRAN POUDEL MD

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EDWARDS RD STE 300
CINCINNATI OH
45209-1288
US

IV. Provider business mailing address

PO BOX 643398
CINCINNATI OH
45264-3398
US

V. Phone/Fax

Practice location:
  • Phone: 513-221-1100
  • Fax: 513-569-5297
Mailing address:
  • Phone: 513-221-1100
  • Fax: 513-569-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.121638
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35.121638
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.121638
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number249273
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number51772
License Number StateMN
# 6
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number35.121638
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: