1760816656 NPI number — MRS. ANGELA M. POLLOCK FNP

Table of content: MRS. ANGELA M. POLLOCK FNP (NPI 1760816656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760816656 NPI number — MRS. ANGELA M. POLLOCK FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLLOCK
Provider First Name:
ANGELA
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BIDDLE
Provider Other First Name:
ANGELA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760816656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 HYGEIA DRIVE, SUITE 2300
Provider Second Line Business Mailing Address:
CCHS PHYSICIAN CONTRACTING
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713-2049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S. MAIN STREET, SUITE 101
Provider Second Line Business Practice Location Address:
SMYRNA HEALTH & WELLNESS CENTER
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19977-1478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-659-4444
Provider Business Practice Location Address Fax Number:
302-659-4495
Provider Enumeration Date:
08/27/2013

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: 363LF0000X , with the licence number:  AC001185 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: LG-0000659 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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