Provider Demographics
NPI:1710951215
Name:POLLOCK, DENZEL WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:DENZEL
Middle Name:WAYNE
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 1:207 N. BROAD STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-361-5020
Mailing Address - Fax:215-362-1195
Practice Address - Street 1:125 MEDICAL CAMPUS DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446
Practice Address - Country:US
Practice Address - Phone:215-361-5836
Practice Address - Fax:215-362-1195
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034419E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001121931001Medicaid
PA516340GT6Medicare PIN