Individual
POONAM SRIVASTAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1575 N OLD TRAIL, SELINSGROVE, PA 17870-9367
(570) 374-8555
(570) 374-9933
Mailing address
1575 N OLD TRAIL, SELINSGROVE, PA 17870-9367
(570) 374-8555
(570) 374-9933
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD039325L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007421000009
—
PA
Enumeration date
07/26/2005
Last updated
11/12/2010
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