Provider Demographics
NPI:1619949385
Name:POMIECKO, JAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:POMIECKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 LINCOLN WAY
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-1714
Mailing Address - Country:US
Mailing Address - Phone:412-678-8740
Mailing Address - Fax:478-678-0772
Practice Address - Street 1:1668 LINCOLN WAY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-1714
Practice Address - Country:US
Practice Address - Phone:412-678-8740
Practice Address - Fax:478-678-0772
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD074010L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057425PD9Medicare ID - Type Unspecified
PAH60379Medicare UPIN