Provider Demographics
NPI:1760459614
Name:POLLACK, IRA A (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:A
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 1:1 JARRETT WHITE RD # 9B-107
Mailing Address - Street 2:
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-6014
Mailing Address - Fax:860-776-2420
Practice Address - Street 1:1 JARRETT WHITE RD # 9B-107
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-6014
Practice Address - Fax:860-776-2420
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2175192084N0400X
CT0410222084N0400X
HI208092084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010041022CT01OtherANTHEM BC/BS
MA68548OtherCIGNA HEALTH PLAN
CT001410224Medicaid
MA32771OtherHEALTH NEW ENGLAND
CT310158OtherAETNA HEALTH PLAN
CT0500815OtherUNITED HEALTH CARE
CT2V3108OtherHEALTH NET
MAJ27188OtherANTHEM BC/BS
CT001410224-00OtherANTHEM BLUE CARE FAMILY
CT041022OtherCONNECTICARE
MA2022940Medicaid
CT6013252-004OtherCIGNA HEALTH CARE
CTP2789075OtherOXFORD HEALTH PLAN
CT6013252-004OtherCIGNA HEALTH CARE
MA32771OtherHEALTH NEW ENGLAND
C44412Medicare UPIN