Active NPI
Thomas Pollack, PH.D.
- Psychologist
- Frederick, MD
National Provider Identifier
1316949647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2750
- Practice address
- 170 Thomas Johnson Dr
Ste 200
Frederick, MD 21702-6200 - Phone
- (301) 695-8390
- Fax
- (301) 694-7906
- NPI assigned
- May 31, 2005
- Reactivated
- Mar 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2750 | MD | Primary |
Addresses
Primary practice location
170 Thomas Johnson Dr
Ste 200
Frederick, MD 21702-6200
Mailing address
170 Thomas Johnson Dr
Frederick, MD 21702-4354
Phone (301) 695-8390
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 339104 | Other | MD | MAMSI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 1, 2015 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2750 | MD | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1316949647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "170 THOMAS JOHNSON DR",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217024354",
"telephone_number": "301-695-8390",
"fax_number": "301-694-7906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "170 THOMAS JOHNSON DR",
"address_2": "STE 200",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217026200",
"telephone_number": "301-695-8390",
"fax_number": "301-694-7906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLACK",
"first_name": "THOMAS",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-31",
"last_updated": "2026-07-13",
"deactivation_date": "2006-03-20",
"reactivation_date": "2006-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "2750",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "339104",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Frederick, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.