Provider Demographics
NPI:1558371351
Name:VILMA E PESSOA MDPA
Entity Type:Organization
Organization Name:VILMA E PESSOA MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PESSOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-262-2092
Mailing Address - Street 1:1710 NORMAN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-5631
Mailing Address - Country:US
Mailing Address - Phone:334-262-2092
Mailing Address - Fax:
Practice Address - Street 1:1710 NORMAN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-5631
Practice Address - Country:US
Practice Address - Phone:334-262-2092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051010265OtherBLUE CROSS #
AL000800080Medicaid
AL000800080Medicaid