Provider Demographics
NPI:1285229187
Name:POMERANTZ, MARC
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:POMERANTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 NW 43RD ST STE E3
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8134
Mailing Address - Country:US
Mailing Address - Phone:352-378-5400
Mailing Address - Fax:352-378-6332
Practice Address - Street 1:3600 NW 43RD ST STE E3
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8134
Practice Address - Country:US
Practice Address - Phone:352-378-5400
Practice Address - Fax:352-378-6332
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA78049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist