MEDICARE: DR. ALEXANDER NATHAN PONTIKOS 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RG0100X	Gastroenterology Physician	35.142428	OH

General Provider Information

NPI Number	:	1235523168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER NATHAN PONTIKOS M.D.

Provider Business Mailing Address
First Line	:	570 WHITE POND DR STE 200
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-4208
Country	:	US
Telephone Number	:	330-869-0954
Fax Number	:

Provider Business Practice Location Address
First Line	:	570 WHITE POND DR STE 200
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-4208
Country	:	US
Telephone Number	:	330-869-0954
Fax Number	:

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

Provider Enumeration Date	:	03/28/2015
Last Update Date	:	07/16/2021

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