Provider Demographics
NPI:1407869191
Name:PONAMGI, VINITA (MD)
Entity Type:Individual
Prefix:MS
First Name:VINITA
Middle Name:
Last Name:PONAMGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VINITA
Other - Middle Name:
Other - Last Name:PONAMGI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1648 HUNTINGDON PIKE
Mailing Address - Street 2:MEDICAL STAFF OFFICE 1ST FLR
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8001
Mailing Address - Country:US
Mailing Address - Phone:215-938-3450
Mailing Address - Fax:215-938-3829
Practice Address - Street 1:910 2ND STREET PIKE STE 111
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1527
Practice Address - Country:US
Practice Address - Phone:215-364-0777
Practice Address - Fax:215-364-4643
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 074022L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
38650Medicare UPIN
048221JWRMedicare ID - Type Unspecified