Provider Demographics
NPI:1700881638
Name:PORTLAND ORTHOPAEDIC FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:PORTLAND ORTHOPAEDIC FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:POMEROY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:207-774-3338
Mailing Address - Street 1:254 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-774-3338
Mailing Address - Fax:207-775-2307
Practice Address - Street 1:254 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2410
Practice Address - Country:US
Practice Address - Phone:207-774-3338
Practice Address - Fax:207-775-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8324Medicare ID - Type Unspecified