Provider Demographics
NPI:1346235173
Name:DAVID P POMEROY MD PS
Entity Type:Organization
Organization Name:DAVID P POMEROY MD PS
Other - Org Name:BRAIN HEALTH NW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:POMEROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-454-8684
Mailing Address - Street 1:2000 116TH AVE NE
Mailing Address - Street 2:STE 6
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3047
Mailing Address - Country:US
Mailing Address - Phone:425-454-8684
Mailing Address - Fax:206-339-5465
Practice Address - Street 1:2000 116TH AVE NE
Practice Address - Street 2:STE 6
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3047
Practice Address - Country:US
Practice Address - Phone:425-454-8684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA15957207Q00000X
WAMD00015957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A08819Medicare UPIN