Provider Demographics
NPI:1639211287
Name:IGNACIO, PAULINE NATIVIDAD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:NATIVIDAD
Last Name:IGNACIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:201 CAROLS PL
Mailing Address - Street 2:#26
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-3915
Mailing Address - Country:US
Mailing Address - Phone:301-979-0052
Mailing Address - Fax:
Practice Address - Street 1:203 CENTENNIAL STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-934-2776
Practice Address - Fax:301-934-1417
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDDO068101208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD142612ZAQYMedicare PIN