MEDICARE: DR. ARJUNA PONNAMBALAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME90027	FL

General Provider Information

NPI Number	:	1326031394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARJUNA PONNAMBALAM M.D.

Provider Business Mailing Address
First Line	:	2350 SCENIC DR
Second Line	:	SENIOR FRIENDSHIP CENTERS, INC.
City	:	VENICE
State	:	FL
Zip	:	34293-1510
Country	:	US
Telephone Number	:	941-584-0043
Fax Number	:	941-496-8627

Provider Business Practice Location Address
First Line	:	2350 SCENIC DR
Second Line	:	SENIOR FRIENDSHIP CENTERS, INC.
City	:	VENICE
State	:	FL
Zip	:	34293-1510
Country	:	US
Telephone Number	:	941-584-0043
Fax Number	:	941-496-8627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	07/08/2007

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