=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609817246
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THEODORE W. POLLOCK DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2006
-----------------------------------------------------
Last Update Date | 12/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1957 OHIO DR
-----------------------------------------------------
City | GROVE CITY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43123-4835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-366-5671
-----------------------------------------------------
Fax | 614-688-7581
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 ACKERMAN RD STE 2120
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43202-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-366-5671
-----------------------------------------------------
Fax | 614-688-7581
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 4678
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 34.002304
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 34.002304
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------