Healthcare Provider Details

I. General information

NPI: 1699717470
Provider Name (Legal Business Name): RICHARD MICHAEL POMERANTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S CATON AVE DEPT. OF MEDICINE, ST. AGNES HOSPITAL
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

900 S CATON AVE DEPT. OF MEDICINE, ST. AGNES HOSPITAL
BALTIMORE MD
21229-5201
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-8723
  • Fax: 410-368-3525
Mailing address:
  • Phone: 410-368-8723
  • Fax: 410-368-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0071086
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: