Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 23086 | SC |
NPI | 1023162286 |
---|---|
Provider Name | Dr. Karen P Pollock |
First Address | Irmo, SC 29063-7616 |
Second Address | Irmo, SC 29063-7616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 22/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
230869 | (05) | SC |
GP5337 | (05) | SC |