Provider Demographics
NPI:1255886099
Name:POLLAK, MEGAN L
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:POLLAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9110 PHILADELPHIA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4301
Mailing Address - Country:US
Mailing Address - Phone:410-686-8922
Mailing Address - Fax:410-686-8923
Practice Address - Street 1:9110 PHILADELPHIA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4301
Practice Address - Country:US
Practice Address - Phone:410-686-8922
Practice Address - Fax:410-686-8923
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist