Provider Demographics
NPI:1093246886
Name:PONNAPAKKAM, ADHARSH
Entity Type:Individual
Prefix:
First Name:ADHARSH
Middle Name:
Last Name:PONNAPAKKAM
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 1:3551 ROGER BROOKE DR
Mailing Address - Street 2:SAN ANTONIO MILITARY MEDICAL CENTER PEDIATRIC RESIDENCY
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-3160
Mailing Address - Fax:210-916-6349
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:SAN ANTONIO MILITARY MEDICAL CENTER PEDIATRIC RESIDENCY
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-3160
Practice Address - Fax:210-916-6349
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31323208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics