Provider Demographics
NPI:1538696646
Name:RAMADAS, POORNIMA ELANGOVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:POORNIMA
Middle Name:ELANGOVAN
Last Name:RAMADAS
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 1:10025 NE 186TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3839
Mailing Address - Country:US
Mailing Address - Phone:425-486-9131
Mailing Address - Fax:425-486-9490
Practice Address - Street 1:10025 NE 186TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3839
Practice Address - Country:US
Practice Address - Phone:425-486-9131
Practice Address - Fax:425-486-9490
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61112257207Q00000X
PAMD471987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT213361OtherRESIDENCY ALLEGHENY ERIE PA