Basic Information
Provider Information
NPI: 1912903733
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POJOL
FirstName: RICARDO
MiddleName: OLAGUIVEL
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 400 LIBERTY HILL RD
Address2:  
City: LUMBERTON
State: NC
PostalCode: 283582446
CountryCode: US
TelephoneNumber: 9107393318
FaxNumber: 9106713600
Practice Location
Address1: 400 LIBERTY HILL RD
Address2:  
City: LUMBERTON
State: NC
PostalCode: 283582446
CountryCode: US
TelephoneNumber: 9107393318
FaxNumber: 9106713600
Other Information
ProviderEnumerationDate: 06/27/2005
LastUpdateDate: 01/05/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080A0000X9501380NCY Allopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine

No ID Information.


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