Healthcare Provider Details

I. General information

NPI: 1619949385
Provider Name (Legal Business Name): JAN POMIECKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 LINCOLN WAY SECOND FLOOR
WHITE OAK PA
15131-1714
US

IV. Provider business mailing address

1668 LINCOLN WAY SECOND FLOOR
WHITE OAK PA
15131-1714
US

V. Phone/Fax

Practice location:
  • Phone: 412-678-8740
  • Fax: 478-678-0772
Mailing address:
  • Phone: 412-678-8740
  • Fax: 478-678-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD074010L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: