Provider Demographics
NPI:1285639690
Name:POMERANZ, STEPHEN JORY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JORY
Last Name:POMERANZ
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 1:5400 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2664
Mailing Address - Country:US
Mailing Address - Phone:513-281-3400
Mailing Address - Fax:
Practice Address - Street 1:5400 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-2664
Practice Address - Country:US
Practice Address - Phone:513-281-3400
Practice Address - Fax:513-527-2275
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0481372085R0202X
GUM-19462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA159081269AMedicaid
OH592032Medicaid
WA8443079Medicaid
NC891245YMedicaid
VA010213894Medicaid
AZ165327Medicaid
MI0M67120Medicare PIN
NH20002182Medicaid
IN100354910Medicaid
KS200383530AMedicaid
OHPO0875348Medicare ID - Type Unspecified
KY64785512Medicaid
E29663Medicare UPIN
NY02622806Medicaid
PA1010599720001Medicaid
SCQ48137Medicaid
AR156113001Medicaid
SD7718910Medicaid
MT0158219Medicaid