=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134225535
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY JOSEPHA POHL M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 CEDAR ST MN DEPT HUMAN SERVICES 64984
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55101-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-431-3431
-----------------------------------------------------
Fax | 651-431-7420
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 806 LINWOOD AVE APT#1
-----------------------------------------------------
City | ST. PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55105-3399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-224-1564
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 27632
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------