=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700880259
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEAN M. POLLOCK M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2005
-----------------------------------------------------
Last Update Date | 08/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44035 RIVERSIDE PKWY STE 400
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20176-8260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-858-5421
-----------------------------------------------------
Fax | 703-858-9573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2901 TELESTAR CT STE 300
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22042-1263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-591-1688
-----------------------------------------------------
Fax | 703-591-1445
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 0101039339
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------