Provider Demographics
NPI:1063416006
Name:POLLACK, ANDREW K (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:K
Last Name:POLLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:501 OFFICE CENTER DR
Practice Address - Street 2:SUITE 195
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3220
Practice Address - Country:US
Practice Address - Phone:215-836-7900
Practice Address - Fax:215-836-7923
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022348E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0057083000OtherKEYSTONE HP EAST
PA0004913OtherAETNA
PAC29807Medicaid
PA091623KS5Medicare ID - Type Unspecified
PA0004913OtherAETNA