Provider Demographics
NPI:1376532481
Name:POMERLEAU, OLGA OLIVERA (MD)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:OLIVERA
Last Name:POMERLEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:OLIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2568A RIVA RD.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7457
Mailing Address - Country:US
Mailing Address - Phone:410-224-7667
Mailing Address - Fax:410-224-7007
Practice Address - Street 1:2568A RIVA RD.
Practice Address - Street 2:SUITE 103
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7457
Practice Address - Country:US
Practice Address - Phone:410-224-7667
Practice Address - Fax:410-224-7007
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237777208000000X
MDD0067152208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010176832Medicaid