Provider Demographics
NPI:1053313395
Name:POMEROY, GREGORY C (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:C
Last Name:POMEROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7291
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:117 AUBURN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6003
Practice Address - Country:US
Practice Address - Phone:207-797-4791
Practice Address - Fax:207-317-5390
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD14031207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME130350099Medicaid
ME200025975OtherRAILROAD MEDICARE
ME5720029OtherAETNA
ME018062OtherANTHEM
ME1447226584-002Medicaid
ME130350099Medicaid
MEMM5965Medicare ID - Type Unspecified