Provider Demographics
NPI:1053408872
Name:PONTASCH, MARTIN JOHANN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOHANN
Last Name:PONTASCH
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 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-526-1280
Mailing Address - Fax:828-526-1285
Practice Address - Street 1:190 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28741-7600
Practice Address - Country:US
Practice Address - Phone:828-526-1200
Practice Address - Fax:828-526-1230
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058998P146D00000X
NC2015-01079207P00000X
FLME100079208D00000X
IL036170623207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0874406Medicaid
NCNCS251BOtherMEDICARE PTAN
NCNCS251AOtherMEDICARE PTAN
NCNCS251A194OtherMEDICARE PTAN
000000344358OtherANTHEM
NCNCS251BOtherMEDICARE PTAN