Provider Demographics
NPI:1699740225
Name:POLLACK, STUART M (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:M
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 1:301 S HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4807
Mailing Address - Country:US
Mailing Address - Phone:857-307-3300
Mailing Address - Fax:
Practice Address - Street 1:301 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4807
Practice Address - Country:US
Practice Address - Phone:857-307-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77170207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0401695OtherEVERCARE
3106381OtherMEDICAID WELFARE
MA3106381Medicaid
4243260OtherAETNA US HEALTHCARE
4422250OtherCIGNA HEALTH PLAN
AA1243OtherHARVARD PILGRIM HEALTHCAR
042472266OtherONE HEALTH PLAN
042472266OtherHEALTHCARE VALUE MANAGMEN
042472266OtherPRIVATE HEALTHCARE SYSTEM
27136OtherCHILDRENS MEDICAL SECURIT
J13510OtherBLUE SHIELD HMO BLUE
J13510OtherBLUE SHIELD INDEMNITY
27136OtherHEALTHY START
1061170OtherFIRST HEALTH
784176OtherMVP HEALTH CARE
J13510OtherBLUE CARE ELECT
J13510OtherMEDICARE B
9901045OtherFALLON COMMUNITY HEALTH P