Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | OS019038 | PA |
NPI | 1023351285 |
---|---|
Provider Name | Mr. Benjamin Bradley Pollock |
First Address | State College, PA 16801-7974 |
Second Address | Mechanicsburg, PA 17050-9413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2013 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103377822 | (05) | PA |