Provider Demographics
NPI:1457884157
Name:POUDEL, BISHNU
Entity Type:Individual
Prefix:
First Name:BISHNU
Middle Name:
Last Name:POUDEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 WOODBOURNE RD STE A2
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1540
Mailing Address - Country:US
Mailing Address - Phone:215-943-2000
Mailing Address - Fax:215-949-2384
Practice Address - Street 1:1411 WOODBOURNE RD STE A2
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1540
Practice Address - Country:US
Practice Address - Phone:215-943-2000
Practice Address - Fax:215-949-2384
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD470680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program