Provider Demographics
NPI:1033184379
Name:PONTIER, PAUL J (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:PONTIER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:713 VOLVO PKWY
Practice Address - Street 2:STE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1614
Practice Address - Country:US
Practice Address - Phone:757-548-0076
Practice Address - Fax:757-548-1652
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101040519207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541595397OtherMID ATLANTIC SOLUTIONS
VA147258OtherANTHEM
VA16539OtherSENTARA/OPTIMA
VA010109931Medicaid
VA541595397OtherCIGNA
VA541595397OtherVIRGINIA HEALTH NETWORK
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA5040715OtherAETNA
VA541595397OtherTRICARE
VA010109931Medicaid
VA16539OtherSENTARA/OPTIMA