Provider Demographics
NPI:1659454528
Name:PUMILIA, PAUL W (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:PUMILIA
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 1:3124 S 19TH ST # 140
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2433
Mailing Address - Country:US
Mailing Address - Phone:253-459-6510
Mailing Address - Fax:
Practice Address - Street 1:3124 S 19TH ST # 140
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2433
Practice Address - Country:US
Practice Address - Phone:253-459-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001-01597207R00000X
WAMD6045014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0637660001OtherPALMETTO GOV. BEN. SERVIC
NC110228992OtherRAILROAD MEDICARE
NC130K7OtherBLUE CROSS BLUE SHIELD
NC89130K7Medicaid
NC04-00886OtherUNITED HEALTHCARE
NC561852981JOtherCIGNA
NC89130K7Medicaid
NC04-00886OtherUNITED HEALTHCARE