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Organization
POCONO ADULT & PEDIATRIC MEDICAL GROUP LLC
Active
Organization
POCONO ADULT & PEDIATRIC MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SOLIBE CHIKAODILI UFONDU M.D. (OWNER)
(570) 476-4161
Entity
Organization
Contact information
Practice address
302 E BROWN ST, SUITE A, EAST STROUDSBURG, PA 18301-3010
(570) 476-4161
(570) 476-9954
Mailing address
302 E BROWN ST, SUITE A, EAST STROUDSBURG, PA 18301-3010
(570) 476-4161
(570) 476-9954
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD062479L
PA
208000000X
Pediatrics Physician
MD062320L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001318932
HIGHMARK
PA
Enumeration date
07/05/2006
Last updated
03/15/2016
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