Provider Demographics
NPI:1972072288
Name:PINO POMMER, PAULA ALEJANDRA (MD)
Entity type:Individual
Prefix:
First Name:PAULA ALEJANDRA
Middle Name:
Last Name:PINO POMMER
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 1:3551 NORTH BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-4160
Mailing Address - Country:US
Mailing Address - Phone:215-430-4022
Mailing Address - Fax:215-430-4247
Practice Address - Street 1:3551 NORTH BROAD ST.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-4160
Practice Address - Country:US
Practice Address - Phone:215-430-4022
Practice Address - Fax:215-430-4247
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALT000810208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice