Provider Demographics
NPI:1043801723
Name:POMERANTZ, KIMBERLY LILLIAN (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LILLIAN
Last Name:POMERANTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 BLACKWELL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3472
Mailing Address - Country:US
Mailing Address - Phone:301-340-1188
Mailing Address - Fax:
Practice Address - Street 1:9601 BLACKWELL RD STE 400
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3472
Practice Address - Country:US
Practice Address - Phone:301-340-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA031767363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical