Provider Demographics
NPI:1518079953
Name:POLLACK, LOUIS DAVID (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:DAVID
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 1:1975 4TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2351
Mailing Address - Country:US
Mailing Address - Phone:415-353-1565
Mailing Address - Fax:
Practice Address - Street 1:1975 4TH ST FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2351
Practice Address - Country:US
Practice Address - Phone:415-353-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015956282NC2000X
CAG1507032080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA06369Medicare UPIN
WA9611906Medicare ID - Type Unspecified