Provider Demographics
NPI:1013907856
Name:POLLACK, MARK HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HARRIS
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 1:1520 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-4106
Mailing Address - Country:US
Mailing Address - Phone:617-285-0866
Mailing Address - Fax:
Practice Address - Street 1:1520 9TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-4106
Practice Address - Country:US
Practice Address - Phone:617-285-0866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA519712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA051971OtherTUFTS HEALTH PLAN
MA051971OtherTUFTS HEALTH PLAN
B74283Medicare UPIN