Basic Information
| Provider Information | |||||||||
| NPI: | 1699717470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POMERANTZ | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 S CATON AVE | ||||||||
| Address2: | DEPT. OF MEDICINE, ST. AGNES HOSPITAL | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212295201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103688723 | ||||||||
| FaxNumber: | 4103683525 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 S CATON AVE | ||||||||
| Address2: | DEPT. OF MEDICINE, ST. AGNES HOSPITAL | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212295201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103688723 | ||||||||
| FaxNumber: | 4103683525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | D0071086 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00040911201 | 01 | NY | UNIVERA | OTHER | 6935 | 01 | NY | BLUE SHIELD | OTHER | NY0027181 | 01 | NY | CHAMPUS | OTHER | 7760214 | 01 | NY | AETNA | OTHER | 2190413 | 01 | NY | INDEPENDENT HEALTH | OTHER | 060020559 | 01 | NY | MEDICARE RAILROAD | OTHER | P010164177 | 01 | NY | BLUE CHOICE | OTHER | 005241971 | 01 | NY | BC/BS OF WESTERN NY | OTHER | 01349600 | 05 | NY | MEDICAID |