Provider Demographics
NPI:1790219335
Name:POOVATHUMKADAVIL, ABDULJALEEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDULJALEEL
Middle Name:
Last Name:POOVATHUMKADAVIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 AUTUMN CREEK LN
Mailing Address - Street 2:APT. F
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2918
Mailing Address - Country:US
Mailing Address - Phone:716-800-9089
Mailing Address - Fax:
Practice Address - Street 1:90 AUTUMN CREEK LN
Practice Address - Street 2:APT. F
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2918
Practice Address - Country:US
Practice Address - Phone:716-800-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAMO3951682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology