Provider Demographics
NPI:1811972821
Name:POMERLEAU, BETTY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:ANN
Last Name:POMERLEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:80 BEHARRELL ST # 80A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-1739
Mailing Address - Country:US
Mailing Address - Phone:781-259-9292
Mailing Address - Fax:781-259-0747
Practice Address - Street 1:80 BEHARRELL ST # 80A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1739
Practice Address - Country:US
Practice Address - Phone:781-259-9292
Practice Address - Fax:781-259-0747
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ30896OtherBLUE CROSS
MA696588OtherHARVARD PILGRIM
MA3193501Medicaid
MA080118OtherTUFTS HEALTH PLAN
MAJ30896Medicare ID - Type Unspecified
MA080118OtherTUFTS HEALTH PLAN