Provider Demographics
NPI:1104819309
Name:POMPELLA, WILLIAM P (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:POMPELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:205 E LAUREL BLVD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2534
Mailing Address - Country:US
Mailing Address - Phone:570-622-1887
Mailing Address - Fax:570-622-1959
Practice Address - Street 1:205 E LAUREL BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2534
Practice Address - Country:US
Practice Address - Phone:570-622-1887
Practice Address - Fax:570-622-1959
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008602L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015871300003Medicaid
PAG24243Medicare UPIN
PA852038Medicare PIN