MEDICARE: OLIVER HENRY POMEROY 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	2085R0202X	Diagnostic Radiology Physician	77640	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F93328BWHT1	OTHER	MA	HARVARD PILGRIM HEALTH CA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	760081	OTHER	MA	TUFTS HEALTH CARE
4	J30858	OTHER	MA	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1295720100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVER HENRY POMEROY M.D.

Provider Business Mailing Address
First Line	:	75 FRANCIS ST
Second Line	:	RADIOLOGY, BRIGHAM AND WOMEN'S HOSPITAL
City	:	BOSTON
State	:	MA
Zip	:	02115-6110
Country	:	US
Telephone Number	:	732-732-9801
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 BOYLSTON ST
Second Line	:	RADIOLOGY, SUITE 5
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-2477
Country	:	US
Telephone Number	:	617-732-9801
Fax Number	:

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	07/01/2011

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