Provider Demographics
NPI:1689692170
Name:POLLOCK, MICHAEL STEPHEN (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:POLLOCK
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 1:121 DOCTORS LN
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8515
Mailing Address - Country:US
Mailing Address - Phone:814-226-3470
Mailing Address - Fax:814-226-3479
Practice Address - Street 1:24 DOCTORS LN
Practice Address - Street 2:SUITE 104
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8568
Practice Address - Country:US
Practice Address - Phone:814-226-1950
Practice Address - Fax:814-226-1951
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA022349E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
252352OtherUPMC
C34002Medicare UPIN
P0430259Medicare ID - Type Unspecified