Provider Demographics
NPI:1609868017
Name:POMERANCE, GLENN NOEL (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:NOEL
Last Name:POMERANCE
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 1:1801 GUNBARREL RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3130
Mailing Address - Country:US
Mailing Address - Phone:423-858-6800
Mailing Address - Fax:423-855-1108
Practice Address - Street 1:1801 GUNBARREL RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3130
Practice Address - Country:US
Practice Address - Phone:423-858-6800
Practice Address - Fax:423-855-1108
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000015600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0393990001OtherDMERC GROUP NUMBER
TNTN0101OtherJOHN DEERE PROVIDER NUMBE
TN3709593OtherMEDICARE GROUP NUMBER
TN3709593Medicaid
TN4139738OtherAETNA PROVIDER NUMBER
TN3008472OtherMEDICARE
TN36857OtherBLUE CROSS PROVIDER NUMBE
TN0452389OtherCIGNA PROVIDER NUMBER
TN180029735OtherRAILRAOD MEDICARE
TNE08611Medicare UPIN