Provider Demographics
NPI:1952765091
Name:PODDAR, KESHAV (MD)
Entity Type:Individual
Prefix:
First Name:KESHAV
Middle Name:
Last Name:PODDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N. BECKLEY AVE.
Mailing Address - Street 2:ATTN DMPN
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-4228
Mailing Address - Country:US
Mailing Address - Phone:214-947-4498
Mailing Address - Fax:214-947-2390
Practice Address - Street 1:1441 N. BECKLEY AVE.
Practice Address - Street 2:ATTN DMPN
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-4228
Practice Address - Country:US
Practice Address - Phone:214-947-4498
Practice Address - Fax:214-947-2390
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty