Provider Demographics
NPI:1780846253
Name:RAMAN S. POOLA M.D. INC
Entity Type:Organization
Organization Name:RAMAN S. POOLA M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAN
Authorized Official - Middle Name:SADASIVASWAMY
Authorized Official - Last Name:POOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:760-242-3000
Mailing Address - Street 1:18523 CORWIN RD
Mailing Address - Street 2:STE H
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2338
Mailing Address - Country:US
Mailing Address - Phone:760-242-3000
Mailing Address - Fax:760-242-1802
Practice Address - Street 1:18523 CORWIN RD
Practice Address - Street 2:STE H
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2338
Practice Address - Country:US
Practice Address - Phone:760-242-3000
Practice Address - Fax:760-242-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A376360Medicare PIN