Provider Demographics
NPI:1528703386
Name:PONDUGULA, PUSHPAK
Entity type:Individual
Prefix:
First Name:PUSHPAK
Middle Name:
Last Name:PONDUGULA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 MARKET STREET
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-349-5890
Mailing Address - Fax:215-349-5890
Practice Address - Street 1:3737 MARKET STREET
Practice Address - Street 2:6TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-349-5890
Practice Address - Fax:215-349-5890
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program