Provider Demographics
NPI:1235837345
Name:PONKO, NOAH ALEXANDER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NOAH
Middle Name:ALEXANDER
Last Name:PONKO
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:117 FOX PLAN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2723
Mailing Address - Country:US
Mailing Address - Phone:412-896-4248
Mailing Address - Fax:412-896-4271
Practice Address - Street 1:117 FOX PLAN RD STE 104
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2723
Practice Address - Country:US
Practice Address - Phone:412-896-4248
Practice Address - Fax:412-896-4271
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA064026363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant