Provider Demographics
NPI:1205013240
Name:POLLOCK, ERIC JON (MSPT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JON
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1330
Mailing Address - Country:US
Mailing Address - Phone:610-275-5437
Mailing Address - Fax:610-275-5477
Practice Address - Street 1:100 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1330
Practice Address - Country:US
Practice Address - Phone:610-275-5437
Practice Address - Fax:610-275-5477
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO11289L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001990705OtherHIGHMARK