MEDICARE: MARIA SOCORRO S PONGOS 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	207R00000X	Internal Medicine Physician	ME80722	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3503308	OTHER	FL	AETNA
2	58040	OTHER	FL	BLUE CROSS
3	404404800	OTHER	FL	CIGNA
4	F9494584306	OTHER	FL	BEECHSTREET
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558304436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA SOCORRO S PONGOS M.D.

Provider Business Mailing Address
First Line	:	6270 CYPRESS GARDENS BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3177
Country	:	US
Telephone Number	:	863-318-1111
Fax Number	:	863-318-1102

Provider Business Practice Location Address
First Line	:	6270 CYPRESS GARDENS BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3177
Country	:	US
Telephone Number	:	863-318-1111
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	10/29/2019

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