Provider Demographics
NPI:1043210628
Name:PRIBULA, PAVEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAVEL
Middle Name:
Last Name:PRIBULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:751 E 16TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2321
Mailing Address - Country:US
Mailing Address - Phone:570-752-5056
Mailing Address - Fax:570-752-0841
Practice Address - Street 1:751 E 16TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2321
Practice Address - Country:US
Practice Address - Phone:570-752-5056
Practice Address - Fax:570-752-0841
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067594L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA160150OtherHIGHMARK
PA48130OtherGEISINGER HEALTH PLAN
PA160150OtherKEYSTONE HEALTH PLAN CENT
PA001794117/0004Medicaid
PACQ88OtherHEALTH AMERICA/HEALTH ASS
PAP006026OtherGATEWAY HEALTH PLAN
PA002112OtherFIRST PRIORITY HEALTH
PA01089801OtherCAPITAL BLUE CROSS
PAPR160150OtherHEALTH ONE
PA01089801OtherCAPITAL BLUE CROSS
PA110213236Medicare ID - Type UnspecifiedMEDICARE RAILROAD
PA160150OtherKEYSTONE HEALTH PLAN CENT
PA002112OtherFIRST PRIORITY HEALTH