Healthcare Provider Details

I. General information

NPI: 1366448516
Provider Name (Legal Business Name): JEAN MARIE POHLOT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WILSON RD
BENTLEYVILLE PA
15314-1027
US

IV. Provider business mailing address

119 WILSON RD
BENTLEYVILLE PA
15314-1027
US

V. Phone/Fax

Practice location:
  • Phone: 724-239-4700
  • Fax: 724-239-3262
Mailing address:
  • Phone: 724-239-4700
  • Fax: 724-239-3262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA002213L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: