Provider Demographics
NPI:1386803971
Name:ROLANDPONARSKIATPROFESSIONALCORPORATION
Entity type:Organization
Organization Name:ROLANDPONARSKIATPROFESSIONALCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNALMEDINICEPHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:PONARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-343-6780
Mailing Address - Street 1:487 ROWLAND DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-8545
Mailing Address - Country:US
Mailing Address - Phone:318-343-6780
Mailing Address - Fax:
Practice Address - Street 1:487 ROWLAND DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-8545
Practice Address - Country:US
Practice Address - Phone:318-343-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD09892R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1967777Medicaid