Provider Demographics
NPI:1083719694
Name:POLLOCK, RAPHAEL E (MD, PHD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:E
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-7171
Mailing Address - Fax:614-293-3465
Practice Address - Street 1:460 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-7171
Practice Address - Fax:614-293-3465
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351218562086X0206X
TXG75652086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088427Medicaid
OHP01387015OtherRAILROAD MEDICARE
OHP01387015OtherRAILROAD MEDICARE
OHP01387015OtherRAILROAD MEDICARE
OHH235500Medicare PIN