MEDICARE: DR. JAMES DOUGLAS POLLOCK D.O.

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	207Q00000X	Family Medicine Physician	OS004363L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	403370	OTHER	PA	HIGHMARK BC/BS
2	0522550	OTHER	PA	TRICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	C33448	OTHER	PA	HEALTH AMERICA

General Provider Information

NPI Number	:	1861497216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DOUGLAS POLLOCK D.O.

Provider Business Mailing Address
First Line	:	1611 PEACH ST
Second Line	:	STE 320
City	:	ERIE
State	:	PA
Zip	:	16501-2122
Country	:	US
Telephone Number	:	814-456-2003
Fax Number	:	814-456-4098

Provider Business Practice Location Address
First Line	:	1611 PEACH ST
Second Line	:	STE 320
City	:	ERIE
State	:	PA
Zip	:	16501-2122
Country	:	US
Telephone Number	:	814-456-2003
Fax Number	:	814-456-4098

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	02/05/2011

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