Provider Demographics
NPI:1881705929
Name:POCONO MEDICAL GROUP & NEPHROLOGY CONSULTANTS, LLC
Entity type:Organization
Organization Name:POCONO MEDICAL GROUP & NEPHROLOGY CONSULTANTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:UMESH
Authorized Official - Middle Name:I
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-421-7292
Mailing Address - Street 1:100 PLAZA CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8258
Mailing Address - Country:US
Mailing Address - Phone:570-421-7292
Mailing Address - Fax:570-421-8351
Practice Address - Street 1:100 PLAZA CT
Practice Address - Street 2:SUITE A
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8258
Practice Address - Country:US
Practice Address - Phone:570-421-7292
Practice Address - Fax:570-421-8351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POCONO MEDICAL GROUP & NEPHROLOGY CONSULTANTS MEDICAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019487880001Medicaid
PA0019487880001Medicaid