Provider Demographics
NPI:1467501114
Name:POMILLA, PAUL V (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:V
Last Name:POMILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:985 PRINCE FREDERICK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3492
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-4850
Practice Address - Street 1:985 PRINCE FREDERICK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3492
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-4850
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46314207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC0410014OtherCAREFIRST OF DC
MD4461101OtherAETNA NON-HMO PCP
MD2148224OtherAETNA HMO PCP
MD836797OtherMAMSI HMO PCP
MD144121300Medicaid
MD110101476OtherRAILROAD MEDICARE
MD53132901OtherCAREFIRST OF MARYLAND
MD2154481OtherAETNA HMO SPECIALIST
MD436797OtherMAMSI HMO SPECIALIST
MD7720001OtherAETNA NON-HMO SPECIALIST
MD436797OtherMAMSI HMO SPECIALIST
MD4461101OtherAETNA NON-HMO PCP