Healthcare Provider Details

I. General information

NPI: 1063416006
Provider Name (Legal Business Name): ANDREW K POLLACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 OFFICE CENTER DR SUITE 195
FT WASHINGTON PA
19034-3220
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7172
US

V. Phone/Fax

Practice location:
  • Phone: 215-836-7900
  • Fax: 215-836-7923
Mailing address:
  • Phone: 407-875-2080
  • Fax: 407-650-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD022348E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: