Basic Information
| Provider Information | |||||||||
| NPI: | 1912238395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLLINO | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CROSSROADS DRIVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211175458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104848088 | ||||||||
| FaxNumber: | 4105819134 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 CROSSROADS DRIVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | OSWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211175458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104848088 | ||||||||
| FaxNumber: | 4105819134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2010 | ||||||||
| LastUpdateDate: | 09/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0004162 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.