Provider Demographics
NPI:1649236928
Name:PONS, WANDA (MD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:PONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:
Other - Last Name:PONS-BAUTISTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:349 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7441
Mailing Address - Country:US
Mailing Address - Phone:412-716-3656
Mailing Address - Fax:
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427560207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014959610001Medicaid
OH2620319Medicaid
PAI48931Medicare UPIN
OH2620319Medicaid
PA097831NJKMedicare PIN