Provider Demographics
NPI:1639219959
Name:WILLIAM M POLLOCK, M.D., PA
Entity Type:Organization
Organization Name:WILLIAM M POLLOCK, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-454-3040
Mailing Address - Street 1:15 OMEGA DR
Mailing Address - Street 2:BLDG K SUITE 2
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2057
Mailing Address - Country:US
Mailing Address - Phone:302-454-3040
Mailing Address - Fax:302-454-7733
Practice Address - Street 1:15 OMEGA DR
Practice Address - Street 2:BLDG K SUITE 2
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2057
Practice Address - Country:US
Practice Address - Phone:302-454-3040
Practice Address - Fax:302-454-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004865208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0192712000OtherAMERIHEALTH
DE27491OtherCOVENTRY
DE100754OtherCIGNA
DE1536348OtherUNITED MINE WORKERS
DE2268802000OtherKEYSTONE
DE2120OtherMIDATLANTIC
DE2268802000OtherINDEPENDANCE BLUE CROSS
DE2353939OtherAETNA
DE0000740401Medicaid
DE444663OtherMAMSI
DE=========OtherBLUE CROSS BLUE SHIELD
DE2120OtherMIDATLANTIC
DE444663OtherMAMSI
DE1536348OtherUNITED MINE WORKERS