Provider Demographics
NPI:1679580310
Name:POBRE-SO, JOSEPHINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:A
Last Name:POBRE-SO
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 955
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-0955
Mailing Address - Country:US
Mailing Address - Phone:267-218-3468
Mailing Address - Fax:215-283-9937
Practice Address - Street 1:2321 N BROAD ST
Practice Address - Street 2:
Practice Address - City:COLMAR
Practice Address - State:PA
Practice Address - Zip Code:18915-9702
Practice Address - Country:US
Practice Address - Phone:267-218-3468
Practice Address - Fax:215-283-9937
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057683L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07235180Medicaid
15-01721OtherEVERCARE
PA01579460Medicaid
PAPO855217OtherBLUEHSHIELD
PA855217FJ1Medicare ID - Type Unspecified
PA07235180Medicaid
15-01721OtherEVERCARE
PA855217Medicare PIN