Provider Demographics
NPI:1578826814
Name:BHERWANI, POONAM ANEEL (MD)
Entity Type:Individual
Prefix:
First Name:POONAM
Middle Name:ANEEL
Last Name:BHERWANI
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 1:107 NEWTOWN RD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-3040
Mailing Address - Country:US
Mailing Address - Phone:203-798-7661
Mailing Address - Fax:203-790-1808
Practice Address - Street 1:107 NEWTOWN RD STE 1D
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4151
Practice Address - Country:US
Practice Address - Phone:203-798-7661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT56342208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics