Provider Demographics
NPI:1700990280
Name:POLLOCK, MADELYN (MD)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6263 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9067
Mailing Address - Country:US
Mailing Address - Phone:214-648-1399
Mailing Address - Fax:214-648-1276
Practice Address - Street 1:6263 HARRY HINES
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9067
Practice Address - Country:US
Practice Address - Phone:214-648-1079
Practice Address - Fax:214-648-1276
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137517211Medicaid
TXC20577Medicare UPIN
TX137517211Medicaid