Basic Information
| Provider Information | |||||||||
| NPI: | 1346777620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADIGALA | ||||||||
| FirstName: | POOJA | ||||||||
| MiddleName: | MOHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 S UTICA AVE STE 460 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185795749 | ||||||||
| FaxNumber: | 9185795762 | ||||||||
| Practice Location | |||||||||
| Address1: | 1145 S UTICA AVE STE 460 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185795749 | ||||||||
| FaxNumber: | 9185795762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2017 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 12/18/2017 | ||||||||
| NPIReactivationDate: | 02/19/2019 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 2022008784 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 35450 | OK | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.