Basic Information
| Provider Information | |||||||||
| NPI: | 1457348625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALOMINO | ||||||||
| FirstName: | NOLA | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 WYOMING ST | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454092740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372249326 | ||||||||
| FaxNumber: | 9372241010 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 WYOMING ST | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454092740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372249326 | ||||||||
| FaxNumber: | 9372241010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 10/25/2010 | ||||||||
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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 | 207ZP0102X | 35032323 | OH | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0386836 | 05 | OH | MEDICAID |