Provider Demographics
NPI:1063493633
Name:POMA, ALLEN MARIO (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:MARIO
Last Name:POMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 VASSAL LN
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-6839
Mailing Address - Country:US
Mailing Address - Phone:617-714-5663
Mailing Address - Fax:
Practice Address - Street 1:150 VASSAL LN
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-6839
Practice Address - Country:US
Practice Address - Phone:617-714-5663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233989207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001369629Medicaid
G73114Medicare UPIN
CT001369629Medicaid