Provider Demographics
NPI:1962465039
Name:POMEROY, DONALD L (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:L
Last Name:POMEROY
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 1:4331 CHURCHMAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1164
Mailing Address - Country:US
Mailing Address - Phone:502-364-0902
Mailing Address - Fax:502-364-0099
Practice Address - Street 1:4331 CHURCHMAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1164
Practice Address - Country:US
Practice Address - Phone:502-364-0902
Practice Address - Fax:502-364-0099
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074485A207X00000X
KY24400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50009264OtherPASSPORT
KY64244007Medicaid
KYP00175871OtherRAILROAD MEDICARE
KY000000348836OtherANTHEM
KY64244007Medicaid
C67961Medicare UPIN
ININ2105002Medicare PIN