Basic Information
| Provider Information | |||||||||
| NPI: | 1255329280 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POUDEL | ||||||||
| FirstName: | DAMODAR | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1049 WESTERN AVE | ||||||||
| Address2: | PO BOX 188 | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456011104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407734366 | ||||||||
| FaxNumber: | 7407757855 | ||||||||
| Practice Location | |||||||||
| Address1: | 1049 WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456011104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407734366 | ||||||||
| FaxNumber: | 7407757855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 10/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35084100P | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 311155352 | 01 | TRICARE | OTHER | 000000341674 | 01 | OH | ANTHEM | OTHER | 311155352 | 01 | AETNA | OTHER | 311155352 | 01 | CIGNA | OTHER | 311155352 | 01 | EV BENEFITS | OTHER | 311155352 | 01 | PPO NEXT | OTHER | 311155352 | 01 | OH | MEDIGOLD | OTHER | 311155352 | 01 | NATIONWIDE INS. | OTHER | 311155352 | 01 | EMERALD HEALTH | OTHER | 311155352 | 01 | UNITED HEALTHCARE | OTHER | 311155352 | 01 | CONNNECTICUT GENERAL | OTHER | 2478117 | 05 | OH | MEDICAID | 311155352 | 01 | CENTRAL BENEFITS | OTHER | 311155352 | 01 | OH | OHIO HEALTH CHOICE | OTHER |