Provider Demographics
NPI:1467743542
Name:HUMBERTO PALLADINO MD, PA
Entity Type:Organization
Organization Name:HUMBERTO PALLADINO MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLADINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-722-1192
Mailing Address - Street 1:5959 GATEWAY BLVD W
Mailing Address - Street 2:120
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3331
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:
Practice Address - Street 1:10175 GATEWAY BLVD W
Practice Address - Street 2:210
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7618
Practice Address - Country:US
Practice Address - Phone:915-590-7900
Practice Address - Fax:915-590-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8437208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB132996Medicare PIN