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General NPI Number Information
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NPI Number | 1962735878
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Entity Type | Individual
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Provider Name | ROBERTO PONO PALMON M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 3905 FORD RD
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City | PHILADELPHIA
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State | PA
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Zip | 19131-2824
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Country | US
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Telephone | 215-452-5170
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Fax |
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Provider Business Mailing Address
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Address Line | 1731 MAGNOLIA LN
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City | NORRISTOWN
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State | PA
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Zip | 19403-3323
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Country | US
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Telephone | 610-630-6900
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD017834E
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License Number State | PA
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