Provider Demographics
NPI:1366448516
Name:POHLOT, JEAN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:POHLOT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15314-1027
Mailing Address - Country:US
Mailing Address - Phone:724-239-4700
Mailing Address - Fax:724-239-3262
Practice Address - Street 1:119 WILSON RD
Practice Address - Street 2:
Practice Address - City:BENTLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15314-1027
Practice Address - Country:US
Practice Address - Phone:724-239-4700
Practice Address - Fax:724-239-3262
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002213L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1366448516OtherNPI
PAKA017505Medicare ID - Type Unspecified