Healthcare Provider Details

I. General information

NPI: 1144300757
Provider Name (Legal Business Name): IDONA C UMALI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W RUDDLE ST
COALDALE PA
18218-1027
US

IV. Provider business mailing address

360 W RUDDLE ST
COALDALE PA
18218-1027
US

V. Phone/Fax

Practice location:
  • Phone: 570-645-8256
  • Fax: 570-645-8875
Mailing address:
  • Phone: 570-645-8256
  • Fax: 570-645-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD030185L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: