Provider Demographics
NPI:1205933850
Name:PANDELLAPALLI, POORNIMA UPADHYAYA (MD)
Entity type:Individual
Prefix:DR
First Name:POORNIMA
Middle Name:UPADHYAYA
Last Name:PANDELLAPALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:POORNIMA
Other - Middle Name:
Other - Last Name:UPADHYAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10204 COLVIN RUN RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-1830
Mailing Address - Country:US
Mailing Address - Phone:703-629-1212
Mailing Address - Fax:
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-677-6038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036167795207RH0003X
VA0101243810207RH0003X
DCMD037507207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology