MEDICARE: MAYA LOUISE PONTE 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	207N00000X	Dermatology Physician	MD460514	PA

General Provider Information

NPI Number	:	1982843140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA LOUISE PONTE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 23329
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-3329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 LOWER STATE RD BLDG 200
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18901-2622
Country	:	US
Telephone Number	:	215-345-6647
Fax Number	:

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

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	03/26/2026

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