Provider Demographics
NPI:1467918250
Name:RAMSDELL, POONAM (PA-C)
Entity type:Individual
Prefix:
First Name:POONAM
Middle Name:
Last Name:RAMSDELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:POONAM
Other - Middle Name:
Other - Last Name:PARMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-4136
Mailing Address - Fax:
Practice Address - Street 1:1304 DRIVING PARK AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1059
Practice Address - Country:US
Practice Address - Phone:315-359-2670
Practice Address - Fax:315-359-2675
Is Sole Proprietor?:No
Enumeration Date:2019-02-16
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024764363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant