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General NPI Number Information
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NPI Number | 1538771464
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Entity Type | Individual
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Provider Name | INDRA PRASAD POUDYAL MD
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Gender | Male
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 219 S WASHINGTON ST
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City | EASTON
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State | MD
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Zip | 21601-2913
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Country | US
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Telephone | 410-822-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1168 SAINT MARKS AVE APT 1F
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City | BROOKLYN
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State | NY
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Zip | 11213-2327
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Country | US
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Telephone | 917-209-8682
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D96211
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License Number State | MD
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