Provider Demographics
NPI:1467491555
Name:POLLARD, JESSICA A (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:A
Last Name:POLLARD
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 1:450 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5450
Mailing Address - Country:US
Mailing Address - Phone:617-632-3270
Mailing Address - Fax:617-632-4410
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-632-3270
Practice Address - Fax:617-632-4410
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2770032080P0207X
MEMD20331208000000X, 2080P0207X
WAMD000426192080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8452187Medicaid
ID807505700Medicaid
WA8860172Medicare ID - Type Unspecified
WAI52973Medicare UPIN