Provider Demographics
NPI:1255329280
Name:POUDEL, DAMODAR (MD)
Entity Type:Individual
Prefix:
First Name:DAMODAR
Middle Name:
Last Name:POUDEL
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 1:1049 WESTERN AVE
Mailing Address - Street 2:PO BOX 188
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1104
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:7335 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3089
Practice Address - Country:US
Practice Address - Phone:614-328-9200
Practice Address - Fax:614-328-9300
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084100P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
311155352OtherCENTRAL BENEFITS
OH000000341674OtherANTHEM
311155352OtherCONNNECTICUT GENERAL
311155352OtherPPO NEXT
OH311155352OtherOHIO HEALTH CHOICE
311155352OtherEMERALD HEALTH
OH2478117Medicaid
OH311155352OtherMEDIGOLD
311155352OtherNATIONWIDE INS.
311155352OtherAETNA
311155352OtherUNITED HEALTHCARE
311155352OtherEV BENEFITS
311155352OtherTRICARE
311155352OtherCIGNA
311155352OtherPPO NEXT
OHPO2025273Medicare PIN