Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 217517 | MA |
Y | 2084N0402X | Child Neurologist | 217517 | MA |
N | 2084N0600X | Clinical Neurophysiologist | 217517 | MA |
NPI | 1275568487 |
---|---|
Provider Name | Dr. Annapurna Poduri |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 09/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2101173 | (05) | MA |
I33477 | (02) | MA |