MEDICARE: KEITH ALLEN POCHICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	2006-00850	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	143X4	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548298557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH ALLEN POCHICK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 601843
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1843
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15235 JOHN J DELANEY DR STE B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2846
Country	:	US
Telephone Number	:	704-243-8937
Fax Number	:	704-243-8926

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	08/19/2021

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