Provider Demographics
NPI:1932467792
Name:POOSARLA, TEJA (MD)
Entity type:Individual
Prefix:
First Name:TEJA
Middle Name:
Last Name:POOSARLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 PAYSPHERE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60067
Mailing Address - Country:US
Mailing Address - Phone:800-322-9183
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:2520 ELISHA AVENUE
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:800-322-9183
Practice Address - Fax:571-472-1294
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101273767207R00000X, 207RX0202X
MS23858207R00000X
ALMD.37162207RH0003X
390200000X
IL036.171938207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program