Healthcare Provider Details

I. General information

NPI: 1437146131
Provider Name (Legal Business Name): MICHAEL POMERANTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WARREN AVE SUITE 401
EAST PROVIDENCE RI
02914-1430
US

IV. Provider business mailing address

10 DAVOL SQ SUITE 400
PROVIDENCE RI
02903-4754
US

V. Phone/Fax

Practice location:
  • Phone: 800-508-4908
  • Fax: 401-228-6236
Mailing address:
  • Phone: 401-421-4000
  • Fax: 401-272-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD07848
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: