Provider Demographics
NPI:1598700684
Name:PONSTINGL, RAANA J (MD)
Entity Type:Individual
Prefix:
First Name:RAANA
Middle Name:J
Last Name:PONSTINGL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAANA
Other - Middle Name:J
Other - Last Name:RASHIDIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2345 DOUGHERTY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3313
Mailing Address - Country:US
Mailing Address - Phone:314-821-5850
Mailing Address - Fax:
Practice Address - Street 1:3635 VISTA AT GRAND BOULEVARD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-268-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36343207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201840915Medicaid
MOP00298784OtherRAILROAD MEDICARE
MO201840915Medicaid
MOP00298784OtherRAILROAD MEDICARE