Provider Demographics
NPI:1144219924
Name:POLLACK, NATHAN M (MD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:M
Last Name:POLLACK
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 1:125 E HAMPDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2546
Mailing Address - Country:US
Mailing Address - Phone:303-788-9292
Mailing Address - Fax:303-788-9260
Practice Address - Street 1:125 E HAMPDEN AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2546
Practice Address - Country:US
Practice Address - Phone:303-788-9292
Practice Address - Fax:303-788-9260
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01195205Medicaid
CO01195205Medicaid
COCO40578Medicare PIN
NDC446348Medicare ID - Type Unspecified