Provider Demographics
NPI:1457348625
Name:PALOMINO, NOLA J (MD)
Entity Type:Individual
Prefix:
First Name:NOLA
Middle Name:J
Last Name:PALOMINO
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 1:160 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2740
Mailing Address - Country:US
Mailing Address - Phone:937-224-9326
Mailing Address - Fax:937-224-1010
Practice Address - Street 1:160 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2740
Practice Address - Country:US
Practice Address - Phone:937-224-9326
Practice Address - Fax:937-224-1010
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032323207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0386836Medicaid
A81544Medicare UPIN
PA0558383Medicare PIN
PA0558382Medicare PIN