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NPI Code Detail

MEDICARE: SAMARA ELISE POLLOCK MD

MEDICARE: SAMARA ELISE POLLOCK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianMD489003PA

General Provider Information

NPI Number : 1184201295
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMARA ELISE POLLOCK MD
Provider Business Mailing Address
First Line : 1516 LOCUST ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-4409
Country : US
Telephone Number : 843-792-2575
Fax Number :
Provider Business Practice Location Address
First Line : 1516 LOCUST ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-4409
Country : US
Telephone Number : 215-545-5459
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2021
Last Update Date : 08/05/2025

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Directions to “ SAMARA ELISE POLLOCK MD” Practice Location

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