Srivastava, Poonam
Srivastava, Poonam is an individual health care provider with primary practice located at 1575 N Old Trail , Selinsgrove PA 17870-9367. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Srivastava, Poonam can be contacted via phone (570) 374-8555.Contact Information
Primary practice address
1575 N Old Trail
Selinsgrove PA 17870-9367
Phone: (570) 374-8555
Fax: (570) 374-9933
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | MD039325L | Pennsylvania |
Profile Details
| NPI number | 1063412757 |
|---|---|
| LBN Legal business name | Srivastava, Poonam |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 26th, 2005 |
| Last updated | Nov 12th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063412757 | NPPES |
| Pennsylvania | MEDICAID | 1007421000009 |
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