Individual
DR. ANANTHASEKAR PONNAMBALAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1601 CENTER STREET, SUITE 1S, MOBILE, AL 36604-3207
(251) 410-5437
(251) 434-3852
Mailing address
PO BOX 40480, MOBILE, AL 36640-0480
(251) 410-5437
(251) 434-3852
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
28395
AL
2080P0206X
Pediatric Gastroenterology Physician
MD424450
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009913082
—
AL
05
—
009913083
—
AL
05
—
07284861
—
MS
05
—
280297000
—
FL
01
—
51545807
BCBS-1504 SPRINGHILL
AL
Enumeration date
06/01/2006
Last updated
03/02/2017
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