Provider Demographics
NPI:1922568096
Name:PONNAIYAN, PRIYA (MD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:PONNAIYAN
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 1:251 NATIONAL HARBOR BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1052
Mailing Address - Country:US
Mailing Address - Phone:301-686-3404
Mailing Address - Fax:
Practice Address - Street 1:251 NATIONAL HARBOR BLVD STE 500
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1052
Practice Address - Country:US
Practice Address - Phone:301-686-3404
Practice Address - Fax:301-686-3407
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0095141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine