Provider Demographics
NPI:1710084348
Name:DELA TORRE, POLA (MD)
Entity Type:Individual
Prefix:DR
First Name:POLA
Middle Name:
Last Name:DELA TORRE
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 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 513
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-963-3715
Practice Address - Fax:856-635-1052
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063242L207RI0200X
NJMA076514207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1567649OtherPENNSYLVANIA BLUE SHIELD
NJ40219OtherUNIVERSITY HEALTH PLAN
NJ60004985OtherHORIZON-NJ HEALTH
NJP00251491OtherRAILROAD MEDICARE
NJ0013684Medicaid
NJ1567649OtherAMERIHEALTH PPO PABS
NJ6526505OtherCIGNA
NJ010005601OtherAMERICHOICE
NJP3106192OtherOXFORD HEALTH PLAN
NJ0013684Medicaid
NJ075661Medicare PIN
NJ1567649OtherAMERIHEALTH PPO PABS