Provider Demographics
NPI:1003232323
Name:POMFRET, SUSAN (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:POMFRET
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 N CHERRY
Mailing Address - Street 2:B
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-4076
Mailing Address - Country:US
Mailing Address - Phone:480-600-0908
Mailing Address - Fax:
Practice Address - Street 1:836 N CHERRY
Practice Address - Street 2:B
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-4076
Practice Address - Country:US
Practice Address - Phone:480-600-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-01433P171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor