Provider Demographics
NPI:1447674858
Name:POUDEL, ATUL (MD)
Entity type:Individual
Prefix:
First Name:ATUL
Middle Name:
Last Name:POUDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:4102 24TH ST STE 303
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1802
Practice Address - Country:US
Practice Address - Phone:806-725-8395
Practice Address - Fax:806-723-7005
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS73162080P0210X, 208000000X, 2080P0210X
MS230242080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1447674858OtherBCBS NM
NM27022242Medicaid
TX8SL700OtherBCBS
TX1447674858Medicaid
TX2I6403OtherMEDICARE