Provider Demographics
NPI:1275131476
Name:PAVLO, IGOR
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:PAVLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 S WHITTMORE ST
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1549
Mailing Address - Country:US
Mailing Address - Phone:267-808-4467
Mailing Address - Fax:
Practice Address - Street 1:2399 S WHITTMORE ST
Practice Address - Street 2:
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925-1549
Practice Address - Country:US
Practice Address - Phone:267-808-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies