MEDICARE: MEGAN L POLLAK

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
1	225100000X	Physical Therapist	26103	MD

General Provider Information

NPI Number	:	1255886099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN L POLLAK

Provider Business Mailing Address
First Line	:	9110 PHILADELPHIA RD
Second Line	:	SUITE 104
City	:	ROSEDALE
State	:	MD
Zip	:	21237-4301
Country	:	US
Telephone Number	:	410-686-8922
Fax Number	:	410-686-8923

Provider Business Practice Location Address
First Line	:	9110 PHILADELPHIA RD
Second Line	:	SUITE 104
City	:	ROSEDALE
State	:	MD
Zip	:	21237-4301
Country	:	US
Telephone Number	:	410-686-8922
Fax Number	:	410-686-8923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2016
Last Update Date	:	08/22/2016

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