Provider Demographics
NPI:1982641973
Name:POKABLA, THOMAS M II (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:POKABLA
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 PEACH ST
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2768
Mailing Address - Country:US
Mailing Address - Phone:814-860-5036
Mailing Address - Fax:
Practice Address - Street 1:145 W 23RD ST
Practice Address - Street 2:SUITE 302A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2858
Practice Address - Country:US
Practice Address - Phone:814-454-5634
Practice Address - Fax:814-454-5639
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005720213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101679029Medicaid
V09343Medicare UPIN
PA101679029Medicaid