Provider Demographics
NPI:1912385477
Name:WERNER, POOJA MIRIAM (MD)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:MIRIAM
Last Name:WERNER
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 1:14080 BIG BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MD
Mailing Address - Zip Code:21036-1253
Mailing Address - Country:US
Mailing Address - Phone:443-812-9334
Mailing Address - Fax:
Practice Address - Street 1:1141 OPAL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5976
Practice Address - Country:US
Practice Address - Phone:301-791-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0085743208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty