Provider Demographics
NPI:1548298557
Name:POCHICK, KEITH ALLEN (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALLEN
Last Name:POCHICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15235 JOHN J DELANEY DR STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2846
Practice Address - Country:US
Practice Address - Phone:704-243-8937
Practice Address - Fax:704-243-8926
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00850207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC143X4OtherBCBS
NC5904115Medicaid
NC2053004Medicare PIN
P00379190Medicare PIN
NCI56788Medicare UPIN