Provider Demographics
NPI:1699880237
Name:POONATI, APPARAO I (MD)
Entity type:Individual
Prefix:MR
First Name:APPARAO
Middle Name:I
Last Name:POONATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440
Mailing Address - Country:US
Mailing Address - Phone:315-339-4544
Mailing Address - Fax:315-338-0679
Practice Address - Street 1:509 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-339-4544
Practice Address - Fax:315-338-0679
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155463207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00891410Medicaid
39907BMedicare ID - Type Unspecified
NY00891410Medicaid