Basic Information
| Provider Information | |||||||||
| NPI: | 1962465039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POMEROY | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4331 CHURCHMAN AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402151164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023640902 | ||||||||
| FaxNumber: | 5023640099 | ||||||||
| Practice Location | |||||||||
| Address1: | 4331 CHURCHMAN AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402151164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023640902 | ||||||||
| FaxNumber: | 5023640099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 05/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 01074485A | IN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 24400 | KY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 50009264 | 01 | KY | PASSPORT | OTHER | 64244007 | 05 | KY | MEDICAID | P00175871 | 01 | KY | RAILROAD MEDICARE | OTHER | 000000348836 | 01 | KY | ANTHEM | OTHER |