Provider Demographics
NPI:1851477152
Name:POONAI, VIKRAMADITYA (MD)
Entity Type:Individual
Prefix:
First Name:VIKRAMADITYA
Middle Name:
Last Name:POONAI
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 1:924 SETON DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1851
Mailing Address - Country:US
Mailing Address - Phone:301-777-5150
Mailing Address - Fax:
Practice Address - Street 1:924 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1851
Practice Address - Country:US
Practice Address - Phone:301-777-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD36766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD53016-1100Medicaid
MD139967Medicare PIN
MDE12789Medicare UPIN
MD6000Medicare ID - Type Unspecified