Healthcare Provider Details

I. General information

NPI: 1598030934
Provider Name (Legal Business Name): JESSE HOLT POHLY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ROMBACH AVE
WILMINGTON OH
45177-2080
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-382-0918
  • Fax: 937-383-1123
Mailing address:
  • Phone: 937-762-1306
  • Fax: 937-522-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50-003478
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: