Provider Demographics
NPI:1699717470
Name:POMERANTZ, RICHARD MICHAEL
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:POMERANTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S CATON AVE
Mailing Address - Street 2:DEPT. OF MEDICINE, ST. AGNES HOSPITAL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5201
Mailing Address - Country:US
Mailing Address - Phone:410-368-8723
Mailing Address - Fax:410-368-3525
Practice Address - Street 1:900 S CATON AVE
Practice Address - Street 2:DEPT. OF MEDICINE, ST. AGNES HOSPITAL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:410-368-8723
Practice Address - Fax:410-368-3525
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071086207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00040911201OtherUNIVERA
NY6935OtherBLUE SHIELD
NYNY0027181OtherCHAMPUS
NY7760214OtherAETNA
NY2190413OtherINDEPENDENT HEALTH
NY060020559OtherMEDICARE RAILROAD
NYP010164177OtherBLUE CHOICE
NY005241971OtherBC/BS OF WESTERN NY
NY01349600Medicaid
NYNY0027181OtherCHAMPUS
NYE27612Medicare UPIN