Provider Demographics
NPI:1164414066
Name:POLLOCK, SHERWIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERWIN
Middle Name:C
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15005 SHADY GROVE RD
Mailing Address - Street 2:STE 110
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6341
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-452-2555
Practice Address - Fax:315-452-2559
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2178422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02082617Medicaid
NY02082617Medicaid
G45181Medicare UPIN
CC1895Medicare PIN
CC1943Medicare PIN
NYP00446450Medicare PIN