Individual
MICHAEL A PONDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2205 PAVILION DR, SUITE 201, KINGSPORT, TN 37660-4641
(423) 857-7650
(423) 857-7655
Mailing address
2205 PAVILION DR, SUITE 201, KINGSPORT, TN 37660-4641
(423) 857-7650
(423) 857-7655
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0101232014
VA
207RC0000X
Cardiovascular Disease Physician
9500424
NC
207RC0000X
Cardiovascular Disease Physician
Primary
MD19887
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831155944
—
VA
05
—
3843357
—
TN
05
—
64011844
—
KY
01
—
P01074944
RAILROAD MEDICARE
TN
Enumeration date
04/26/2006
Last updated
02/21/2017
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