Individual ProviderVandana PothalaStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address1901 First Avenue Room 523, Department Of Pediatrics, Metropolitan Hospital Center, New York, NY 10029(212) 423-6288PECOS EnrollmentBased on the most recent information from CMS, provider Vandana Pothala does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1417531922Provider TypeIndividualFull NamePothala, VandanaTitleMs.CredentialM.B.B.SGenderFemaleSole ProprietorNoEnumeration Date5/11/2021Last Updated8/4/2022Contact InformationPractice LocationPractice Address1901 First Avenue Room 523, Department Of Pediatrics, Metropolitan Hospital Center, New York, NY 10029Phone(212) 423-6288FaxUnlisted FaxMailing LocationMailing Address1901 First Avenue Room 523, Department Of Pediatrics, Metropolitan Hospital Center, New York, NY 10029Phone(212) 423-6288FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer