Provider Demographics
NPI:1093745879
Name:POLLAK, CHARITY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:ANN
Last Name:POLLAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 S UTICA AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4015
Mailing Address - Country:US
Mailing Address - Phone:918-960-2006
Mailing Address - Fax:917-900-1813
Practice Address - Street 1:1145 S UTICA AVE STE 403
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4015
Practice Address - Country:US
Practice Address - Phone:918-960-2006
Practice Address - Fax:918-900-1813
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22460208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200002110AMedicaid
OK200002110BMedicaid
OKI31347Medicare UPIN