Provider Demographics
NPI:1801033899
Name:POLLOCK, SIMEON (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:SIMEON
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 CAMERON STREET
Mailing Address - Street 2:SUITE 602
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4110
Mailing Address - Country:US
Mailing Address - Phone:301-495-0303
Mailing Address - Fax:
Practice Address - Street 1:8830 CAMERON CT
Practice Address - Street 2:SUITE 602
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4114
Practice Address - Country:US
Practice Address - Phone:301-495-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDUO1179171100000X
MDM02382172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM903OtherCAREFIRST BLUE CROSS BLUE SHIELD
MDFB48SOtherCAREFIRST BLUE CROSS BLUE SHIELD