Provider Demographics
NPI:1053319574
Name:POLLOCK, JEFFREY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:POLLOCK
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 1:227 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1325
Mailing Address - Country:US
Mailing Address - Phone:215-357-7546
Mailing Address - Fax:215-357-3924
Practice Address - Street 1:2600 PHILMONT AVE STE 309
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-5309
Practice Address - Country:US
Practice Address - Phone:215-938-1700
Practice Address - Fax:215-947-7546
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-04-11
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
PAMD019556E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28418Medicare UPIN
PA49654Medicare ID - Type UnspecifiedMEDICARE ID