Individual
MADHUSUDHAN PONNALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
503 N 21ST ST, CAMP HILL, PA 17011-2204
(717) 972-4448
(717) 972-7366
Mailing address
503 N 21ST ST, CAMP HILL, PA 17011-2204
(717) 972-4448
(717) 972-7366
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
MD465055
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1035770640001
—
PA
01
—
717918
MEDICARE
PA
Enumeration date
06/19/2013
Last updated
05/16/2023
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