1629063052 NPI number — DR. ALAN J POLLACK MD

Table of content: DR. ALAN J POLLACK MD (NPI 1629063052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629063052 NPI number — DR. ALAN J POLLACK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLLACK
Provider First Name:
ALAN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1629063052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4660 KENMORE AVE
Provider Second Line Business Mailing Address:
SUITE 416
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22304-1313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-751-0700
Provider Business Mailing Address Fax Number:
703-751-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4660 KENMORE AVE
Provider Second Line Business Practice Location Address:
SUITE 416
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22304-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-751-0700
Provider Business Practice Location Address Fax Number:
703-751-2020
Provider Enumeration Date:
09/12/2005

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: 207W00000X , with the licence number:  0101225387 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 286919 . This is a "MAMSI/ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 140021 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6300162 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A937-0002 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7125122 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 345382 . This is a "NCPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 540947194 . This is a "UNITED HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2391760 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".




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