Provider Demographics
NPI:1093789935
Name:POMERANTZ, SANFORD EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:EDWARD
Last Name:POMERANTZ
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 1:7419 SW FOUNTAINDALE RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4665
Mailing Address - Country:US
Mailing Address - Phone:785-478-3419
Mailing Address - Fax:785-478-3808
Practice Address - Street 1:3601 SW 29TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2015
Practice Address - Country:US
Practice Address - Phone:785-478-3808
Practice Address - Fax:785-478-3808
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-152932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB90996Medicare UPIN
KS000454Medicare ID - Type Unspecified