Provider Demographics
NPI:1235974106
Name:PONNABOINA, DIVYA MADHURI
Entity type:Individual
Prefix:
First Name:DIVYA MADHURI
Middle Name:
Last Name:PONNABOINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3188 BELLEVUE AVENUE
Mailing Address - Street 2:DEPT OF PATHOLOGY AND LABORATORY MEDICINE, SUITE 110 ML
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-584-7284
Mailing Address - Fax:
Practice Address - Street 1:3188 BELLEVUE AVENUE
Practice Address - Street 2:DEPT OF PATHOLOGY AND LABORATORY MEDICINE, SUITE 110 ML
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-584-7284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program