MEDICARE: DR. MARY JOSEPHA POHL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	27632	MN

General Provider Information

NPI Number	:	1134225535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY JOSEPHA POHL M.D.

Provider Business Mailing Address
First Line	:	806 LINWOOD AVE
Second Line	:	APT#1
City	:	ST. PAUL
State	:	MN
Zip	:	55105-3399
Country	:	US
Telephone Number	:	651-224-1564
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 CEDAR ST
Second Line	:	MN DEPT HUMAN SERVICES 64984
City	:	SAINT PAUL
State	:	MN
Zip	:	55101-2208
Country	:	US
Telephone Number	:	651-431-3431
Fax Number	:	651-431-7420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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