Provider Demographics
NPI: | 1457394942 |
---|---|
Name: | POLLAK, ANDREW (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ANDREW |
Middle Name: | |
Last Name: | POLLAK |
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: | PO BOX 64881 |
Mailing Address - Street 2: | |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21264-4881 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-448-6375 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 22 S GREENE ST |
Practice Address - Street 2: | |
Practice Address - City: | BALTIMORE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21201-1544 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-328-5596 |
Practice Address - Fax: | 410-328-7222 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-13 |
Last Update Date: | 2010-07-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | D0046401 | 207P00000X, 207PE0004X, 207PE0005X, 207PP0204X, 207PS0010X, 207X00000X, 207XS0106X, 207XS0114X, 207XS0117X, 207XX0004X, 207XX0005X, 207XX0801X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207XX0801X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | |
No | 207PE0004X | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No | 207PE0005X | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine |
No | 207PP0204X | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
No | 207PS0010X | Allopathic & Osteopathic Physicians | Emergency Medicine | Sports Medicine |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 1457394942 | Other | NPI |
MD | 334721400 | Medicaid | |
MD | 842F | Medicare PIN | |
MD | P00068152 | Medicare PIN | |
MD | F67536 | Medicare UPIN |