Provider Demographics
NPI:1982691523
Name:POLLOCK, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LOCUST ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-5136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5114
Practice Address - Country:US
Practice Address - Phone:412-232-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063250L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5053695OtherAETNA PIN
PA1513498OtherGATEWAY
PA567777JK6OtherPA MCR GROUP PTAN
PA0016588210006OtherMEDICAID PA GROUP PIN
PA83370OtherUNISON
PA0016588210006Medicaid
PA260850OtherBCBS
PA1742638OtherAETNA PVN
PA251164OtherUPMC
PA567777JK6OtherPA MCR GROUP PTAN
PA901479JK6Medicare ID - Type Unspecified