1023093127 NPI number — WENDY POLLOCK DC

Table of content: WENDY POLLOCK DC (NPI 1023093127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023093127 NPI number — WENDY POLLOCK DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLLOCK
Provider First Name:
WENDY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023093127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04104-8406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-370-8330
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83 INDIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101-4210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-370-8330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  011475 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200941097 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: CR620 . This is a "LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: M51022 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 114150000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4414946 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: MNT021 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 022665 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 114150000 . This is a "MAINE CARE" identifier . This identifiers is of the category "OTHER".




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