Healthcare Provider Details

I. General information

NPI: 1174227904
Provider Name (Legal Business Name): LATISHA POLLARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 WEST AVE
NORWALK CT
06850-4004
US

IV. Provider business mailing address

637 WEST AVE
NORWALK CT
06850-4004
US

V. Phone/Fax

Practice location:
  • Phone: 203-276-7870
  • Fax: 203-276-7883
Mailing address:
  • Phone: 203-276-7870
  • Fax: 203-276-7883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number086308
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: