Provider Demographics
NPI:1205805470
Name:POUDYAL, MONITA (MD)
Entity type:Individual
Prefix:DR
First Name:MONITA
Middle Name:
Last Name:POUDYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2594 TRAILRIDGE DR E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3186
Mailing Address - Country:US
Mailing Address - Phone:303-449-7740
Mailing Address - Fax:303-604-5393
Practice Address - Street 1:2594 TRAILRIDGE DR E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3186
Practice Address - Country:US
Practice Address - Phone:303-449-7740
Practice Address - Fax:303-604-5393
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44430207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02904888Medicaid
CO805316Medicare ID - Type Unspecified
COI51943Medicare UPIN