Provider Demographics
NPI:1841203254
Name:POMICTER, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:POMICTER
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:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:SINGERS GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22850-0001
Mailing Address - Country:US
Mailing Address - Phone:802-318-7694
Mailing Address - Fax:
Practice Address - Street 1:7566 TURLEYTOWN RD
Practice Address - Street 2:
Practice Address - City:SINGERS GLEN
Practice Address - State:VA
Practice Address - Zip Code:22850-2122
Practice Address - Country:US
Practice Address - Phone:802-318-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009904207L00000X, 207LP2900X
VA0101257259208D00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2124Medicaid
H06228Medicare UPIN
VT0VN2124Medicaid