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General NPI Number Information
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NPI Number | 1194099333
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Entity Type | Individual
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Provider Name | POONAM MISHRA M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 10 CENTER DR. NIH/NIDDK
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City | BETHESDA
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State | MD
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Zip | 20892-0001
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Country | US
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Telephone | 301-497-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 10903 NEW HAMPSHIRE AVE BUILDING -22 ROOM# 6367
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City | SILVER SPRING
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State | MD
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Zip | 20903-1058
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Country | US
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Telephone | 301-796-1500
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Fax | 301-796-9883
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0062748
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License Number State | MD
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