Provider Demographics
NPI:1558319780
Name:POLLOCK, BRIAN A (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 23RD ST.
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223
Mailing Address - Country:US
Mailing Address - Phone:330-929-2685
Mailing Address - Fax:330-929-2687
Practice Address - Street 1:1900 23RD ST.
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223
Practice Address - Country:US
Practice Address - Phone:330-929-2685
Practice Address - Fax:330-929-2687
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2525619Medicaid
I08887Medicare UPIN
OH2525619Medicaid