MEDICARE: SUSAN B POLLAN M.D.

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	207L00000X	Anesthesiology Physician	75361	MA
2	208VP0000X	Pain Medicine Physician	ME87957	MA
3	207R00000X	Internal Medicine Physician	ME87957	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770584252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN B POLLAN M.D.

Provider Business Mailing Address
First Line	:	6349 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2707
Country	:	US
Telephone Number	:	904-721-1919
Fax Number	:	904-721-1914

Provider Business Practice Location Address
First Line	:	6349 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2707
Country	:	US
Telephone Number	:	904-721-1919
Fax Number	:	904-721-1914

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/05/2021

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Directions to “ SUSAN B POLLAN M.D.” Practice Location

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