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NPI Code Detail

MEDICARE: JYOTHSNA PONNURI MD

MEDICARE: JYOTHSNA PONNURI MD
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
1207R00000XInternal Medicine Physician237800NY
2207RG0300XGeriatric Medicine (Internal Medicine) Physician237800NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00388646OTHERNYMEDICARE, RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972532554
Entity Type Code : Individual
Provider Name (Legal Business Name) : JYOTHSNA PONNURI MD
Provider Business Mailing Address
First Line : 2021 WINTON ROAD S
Second Line : JEWISH HOME OF ROCHESTER
City : ROCHESTER
State : NY
Zip : 14618-3957
Country : US
Telephone Number : 585-784-6400
Fax Number : 585-341-2370
Provider Business Practice Location Address
First Line : 2021 WINTON ROAD S
Second Line : JEWISH HOME OF ROCHESTER
City : ROCHESTER
State : NY
Zip : 14618-3957
Country : US
Telephone Number : 585-784-6400
Fax Number : 585-341-2370
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2006
Last Update Date : 02/15/2016

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Directions to “ JYOTHSNA PONNURI MD” Practice Location

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