Provider Demographics
NPI:1215929112
Name:POBLETE, PIO L (MD)
Entity type:Individual
Prefix:DR
First Name:PIO
Middle Name:L
Last Name:POBLETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7580 BUCKINGHAM BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3210
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:5900 WATERLOO RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2641
Practice Address - Country:US
Practice Address - Phone:410-740-2900
Practice Address - Fax:410-992-0732
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110161664OtherRR MEDICARE
MD543574-02OtherCAREFIRST MD RENDERING
MD029921OtherJHHC PROVIDER NUMBER
MD0568716OtherAETNA CAPITATED
MD443211800Medicaid
MDP12724OtherCAREFIRST MPOS
MD5918117OtherAETNA FEE FOR SERVICE
MD860239OtherMAMSI PRIMARY CARE
MD3509-0009OtherCAREFIRST BLUECHOICE
MD260239OtherMAMSI SPECIALIST
MD3117511OtherCIGNA PIN
MD3509-0009OtherCAREFIRST BLUECHOICE
MD226L742TMedicare PIN