Provider Demographics
NPI:1285138487
Name:PASTORAL, MARY LAREINE (MD)
Entity type:Individual
Prefix:
First Name:MARY LAREINE
Middle Name:
Last Name:PASTORAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY LAREINE
Other - Middle Name:VASQUEZ
Other - Last Name:PASTORAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 ALTAIR PKWY STE 3300
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7653
Mailing Address - Country:US
Mailing Address - Phone:614-882-0708
Mailing Address - Fax:330-615-3284
Practice Address - Street 1:400 ALTAIR PKWY STE 3300
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7653
Practice Address - Country:US
Practice Address - Phone:614-882-0708
Practice Address - Fax:330-375-7779
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.141488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program