Provider Demographics
NPI:1861497216
Name:POLLOCK, JAMES DOUGLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 PEACH ST
Mailing Address - Street 2:STE 320
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2122
Mailing Address - Country:US
Mailing Address - Phone:814-456-2003
Mailing Address - Fax:814-456-4098
Practice Address - Street 1:1611 PEACH ST
Practice Address - Street 2:STE 320
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2122
Practice Address - Country:US
Practice Address - Phone:814-456-2003
Practice Address - Fax:814-456-4098
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004363L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA403370OtherHIGHMARK BC/BS
PA0522550OtherTRICARE
PA000904644Medicaid
PAC33448OtherHEALTH AMERICA
PA000904644Medicaid
PAC33448Medicare UPIN
PA403370NM8Medicare PIN