Provider Demographics
NPI:1114423704
Name:PONDER, MICHELLE (MD, DABOM)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:PONDER
Suffix:
Gender:F
Credentials:MD, DABOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DUKE MEDICINE CIRCLE
Mailing Address - Street 2:CLINIC 1A
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710
Mailing Address - Country:US
Mailing Address - Phone:919-684-3600
Mailing Address - Fax:
Practice Address - Street 1:30 DUKE MEDICINE CIRCLE
Practice Address - Street 2:CLINIC 1A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710
Practice Address - Country:US
Practice Address - Phone:919-684-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC301847207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism