Provider Demographics
NPI:1558355347
Name:POLLACK, BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
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 1:1305 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6016
Mailing Address - Country:US
Mailing Address - Phone:203-292-2000
Mailing Address - Fax:203-255-5212
Practice Address - Street 1:25 GERMANTOWN RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5013
Practice Address - Country:US
Practice Address - Phone:203-794-0090
Practice Address - Fax:203-830-4614
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT32835174400000X
CT032835207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001328352Medicaid
CT001328352Medicaid
CT060001697Medicare PIN