Individual
PAUL H PRONOVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-4600
(215) 707-9697
Mailing address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-4600
(215) 707-9697
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
037779
CT
207RN0300X
Nephrology Physician
Primary
MD049051L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001377797
—
CT
Enumeration date
08/29/2006
Last updated
11/24/2020
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