Provider Demographics
NPI:1558367250
Name:POMPER, JOHN L (CRNA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:POMPER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-1776
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:201-804-2800
Mailing Address - Fax:
Practice Address - Street 1:111 S 11TH ST # 8490
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-6161
Practice Address - Fax:215-923-5507
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-246719-L163W00000X
PA038533367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA84347OtherGEISINGER
PA0448668OtherFIRST PRIORITY
PA50026737OtherCAPITAL ADVANTAGE
PA728009000OtherIBC
PA0448668OtherHIGHMARK
PA2000104OtherKHP CENTRAL
PA1585157OtherGATEWAY
PA9532437OtherAETNA
S58215Medicare UPIN
PA0448668OtherHIGHMARK
PA448668QCYMedicare PIN
PA448668Medicare PIN