Provider Demographics
NPI:1750365086
Name:MILLAN, POALA GALVEZ (MD)
Entity type:Individual
Prefix:DR
First Name:POALA
Middle Name:GALVEZ
Last Name:MILLAN
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 2429
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28502-2429
Mailing Address - Country:US
Mailing Address - Phone:252-522-0335
Mailing Address - Fax:252-522-4016
Practice Address - Street 1:2509 NORTH QUEEN ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28502
Practice Address - Country:US
Practice Address - Phone:252-522-0335
Practice Address - Fax:252-522-4016
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1387AOtherBCBS
NC15900222Medicaid
NC15900222Medicaid