Provider Demographics
NPI:1912715780
Name:POLLARD, TYRIQ MARVIN
Entity type:Individual
Prefix:MR
First Name:TYRIQ
Middle Name:MARVIN
Last Name:POLLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 14TH ST NW APT 819
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1352
Mailing Address - Country:US
Mailing Address - Phone:202-460-6720
Mailing Address - Fax:
Practice Address - Street 1:3500 14TH ST NW APT 819
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1352
Practice Address - Country:US
Practice Address - Phone:202-460-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant