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General NPI Number Information
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NPI Number | 1093246886
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Entity Type | Individual
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Provider Name | ADHARSH PONNAPAKKAM
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Gender | Male
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 3551 ROGER BROOKE DR SAN ANTONIO MILITARY MEDICAL CENTER PEDIATRIC RESIDENCY
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City | SAN ANTONIO
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-916-3160
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Fax | 210-916-6349
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Provider Business Mailing Address
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Address Line | 3551 ROGER BROOKE DR SAN ANTONIO MILITARY MEDICAL CENTER PEDIATRIC RESIDENCY
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City | SAN ANTONIO
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-916-3160
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Fax | 210-916-6349
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 31323
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License Number State | NE
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