Healthcare Provider Details

I. General information

NPI: 1700881638
Provider Name (Legal Business Name): PORTLAND ORTHOPAEDIC FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 WESTERN AVE
SOUTH PORTLAND ME
04106-2410
US

IV. Provider business mailing address

254 WESTERN AVE
SOUTH PORTLAND ME
04106
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-3338
  • Fax: 207-775-2307
Mailing address:
  • Phone: 207-774-3338
  • Fax: 207-775-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY C POMEROY JR.
Title or Position: ORTHOPAEDIC SURGEON
Credential: M.D.
Phone: 207-774-3338