Basic Information
| Provider Information | |||||||||
| NPI: | 1275529075 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEMA | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 S 18TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432052696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147224950 | ||||||||
| FaxNumber: | 6147224966 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 S 18TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432052696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147224950 | ||||||||
| FaxNumber: | 6147224966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 11/20/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35061833 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 109692000 | 05 | WV | MEDICAID | 0860475 | 05 | OH | MEDICAID | 64951270 | 05 | KY | MEDICAID |