Provider Demographics
NPI:1164475034
Name:POMERANTS, B J (MD)
Entity Type:Individual
Prefix:
First Name:B
Middle Name:J
Last Name:POMERANTS
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 536
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0536
Mailing Address - Country:US
Mailing Address - Phone:740-587-1361
Mailing Address - Fax:740-587-1362
Practice Address - Street 1:7450 HOSPITAL DR
Practice Address - Street 2:STE 150
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9641
Practice Address - Country:US
Practice Address - Phone:614-766-5050
Practice Address - Fax:614-766-8080
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064162208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64954399Medicaid
WV0126463000Medicaid
000000122157OtherANTHEM
020039709OtherMEDICARE RAILROAD
OH0975851Medicaid
OH0975851Medicaid