Provider Demographics
NPI:1477515088
Name:POMERANZ, MARK (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:POMERANZ
Suffix:
Gender:M
Credentials:DO
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 14892
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4043
Mailing Address - Country:US
Mailing Address - Phone:704-749-5800
Mailing Address - Fax:704-973-0815
Practice Address - Street 1:760 MCGUIRE PL 1
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1630
Practice Address - Country:US
Practice Address - Phone:757-596-2762
Practice Address - Fax:757-595-2001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102037032207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F04289Medicare UPIN