Provider Demographics
NPI:1588645212
Name:POLLACK, DEBRA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANN
Last Name:POLLACK
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 1:31 STAPLES ST
Mailing Address - Street 2:CENTER FOR COMPREHENSIVE CARE
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5323
Mailing Address - Country:US
Mailing Address - Phone:203-225-0504
Mailing Address - Fax:203-792-1675
Practice Address - Street 1:31 STAPLES ST
Practice Address - Street 2:CENTER FOR COMPREHENSIVE CARE
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5323
Practice Address - Country:US
Practice Address - Phone:203-225-0504
Practice Address - Fax:203-792-1675
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT354802084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1354802Medicaid
CTG35636Medicare UPIN
CT130000499Medicare ID - Type Unspecified