Basic Information
Provider Information | |||||||||
NPI: | 1386734838 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | POMMETT | ||||||||
FirstName: | ERIKA | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 9 INDUSTRIAL RD | ||||||||
Address2: | SUITE 5 | ||||||||
City: | MILFORD | ||||||||
State: | MA | ||||||||
PostalCode: | 017573735 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5084731480 | ||||||||
FaxNumber: | 5084731210 | ||||||||
Practice Location | |||||||||
Address1: | 100 COMMERCE DR | ||||||||
Address2: |   | ||||||||
City: | NORTHBRIDGE | ||||||||
State: | MA | ||||||||
PostalCode: | 015341415 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5082346311 | ||||||||
FaxNumber: | 5082344215 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/13/2006 | ||||||||
LastUpdateDate: | 12/12/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 02002640A | IN | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 237184 | MA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.