Provider Demographics
NPI:1154715647
Name:POMERANTZ, MARIBETH (CNM)
Entity type:Individual
Prefix:MS
First Name:MARIBETH
Middle Name:
Last Name:POMERANTZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NORTH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4172
Mailing Address - Country:US
Mailing Address - Phone:413-499-8570
Mailing Address - Fax:
Practice Address - Street 1:777 NORTH ST STE 301
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4172
Practice Address - Country:US
Practice Address - Phone:413-499-8570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN229380367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife