Provider Demographics
NPI:1609898550
Name:PESSOA, VILMA ESLA (MD)
Entity Type:Individual
Prefix:
First Name:VILMA
Middle Name:ESLA
Last Name:PESSOA
Suffix:
Gender:F
Credentials:MD
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 70365
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-0365
Mailing Address - Country:US
Mailing Address - Phone:334-420-5001
Mailing Address - Fax:334-420-0158
Practice Address - Street 1:1000 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-4404
Practice Address - Country:US
Practice Address - Phone:334-263-2301
Practice Address - Fax:334-263-1129
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00004362208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76811Medicare UPIN