Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Marlo Pichardo, PAC

Individual provider Physician Assistant · NPI 1699842021

Marlo Pichardo, PAC is a Physician Assistant in Eagle, Idaho. Qualified in 1999, 27 years ago. Practices with Momentum Medical Group of Idaho LLC, an 8-clinician group and accepts Medicare assignment. Licensed in Florida and Idaho.

Years since qualifying
27
Licensed in
FL, ID
In the registry since
2006
Specialties on file
2
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

408 S Eagle Rd Ste 205
Eagle, ID 83616-6079
Phone: (208) 740-8797
Fax: (530) 237-0772
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA-1898 (ID)
Physician Assistant Taxonomy 363A00000X · Licence PA9102903 (FL)

Record details

NPI number1699842021
Entity typeIndividual (Type 1)
GenderFemale
Credentials PAC
Sole proprietorNo
NPI enumeratedNovember 29, 2006
Last updated in NPPESFebruary 13, 2026
Certification dateFebruary 13, 2026
Mailing address408 S Eagle Rd Ste 205, Eagle, ID 83616-6079

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1999 (27 years in practice)
Group practice Momentum Medical Group Of Idaho Llc — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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