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General NPI Number Information
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NPI Number | 1063493633
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Entity Type | Individual
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Provider Name | ALLEN MARIO POMA MD
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 150 VASSAL LN
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City | CAMBRIDGE
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State | MA
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Zip | 02138-6839
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Country | US
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Telephone | 617-714-5663
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Fax |
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Provider Business Mailing Address
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Address Line | 852 WINTER ST
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City | WALTHAM
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State | MA
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Zip | 02451-1439
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Country | US
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Telephone | 617-945-4594
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 233989
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License Number State | MA
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