Dr PAVANKUMAR BOMMASAMUDRAM is a male medical professional, specializing in Internal Medicine. He graduated in 2008.
NORTHEASTERN HEALTH SYSTEM
1400 E DOWNING ST
TAHLEQUAH
OK
744643324
Tel: 9184560641
| Npi | 1639306293 |
| Pac Id | 3779749478 |
| Professional Enrollment Id | I20120725000093 |
| Last Name | BOMMASAMUDRAM |
| First Name | PAVANKUMAR |
| Middle Name | |
| Suffix | |
| Gender | M |
| Credential | |
| Medical School Name | OTHER |
| Graduation Year | 2008 |
| Primary Specialty | INTERNAL MEDICINE |
| Secondary Specialty 1 | |
| Secondary Specialty 2 | |
| Secondary Specialty 3 | |
| Secondary Specialty 4 | |
| All Secondary Specialties | |
| Organization Legal Name | NORTHEASTERN HEALTH SYSTEM |
| Group Practice Pac Id | 1456255025 |
| Number Of Group Practice Members | 58 |
| Line 1 Street Address | 1400 E DOWNING ST |
| Line 2 Street Address | |
| Marker Of Address Line 2 Suppression | |
| City | TAHLEQUAH |
| State | OK |
| Zip Code | 744643324 |
| Phone Number | 9184560641 |
| Hospital Affiliation Ccn 1 | 171383 |
| Hospital Affiliation Lbn 1 | WILLIAM NEWTON HOSPITAL |
| Hospital Affiliation Ccn 2 | 370089 |
| Hospital Affiliation Lbn 2 | NORTHEASTERN HEALTH SYSTEM |
| Hospital Affiliation Ccn 3 | 370171 |
| Hospital Affiliation Lbn 3 | CHEROKEE NATION W W HASTINGS INDIAN HOSPITAL |
| Hospital Affiliation Ccn 4 | 370112 |
| Hospital Affiliation Lbn 4 | SEQUOYAH COUNTY-CITY OF SALLISAW HOSPITAL AUTHORIT |
| Hospital Affiliation Ccn 5 | 170150 |
| Hospital Affiliation Lbn 5 | SOUTH CENTRAL KS MED CENTER |
| Professional Accepts Medicare Assignment | Y |
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