Provider Demographics
NPI:1083798979
Name:POLASCIK, THOMAS JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:POLASCIK
Suffix:
Gender:M
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:PO BOX 2804 RM 1089
Mailing Address - Street 2:DUKE SOUTH, DUKE UNIVERSITY MEDICAL CENTER
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-684-4946
Mailing Address - Fax:919-684-5220
Practice Address - Street 1:DUKE CANCER CENTER 5-1 UROLOGY
Practice Address - Street 2:DUKE CANCER CENTER, DUKE UNIVERSITY MEDICAL CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-684-4946
Practice Address - Fax:919-684-5220
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-01017208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911593Medicaid
NC11593OtherBCBS
NC2259905AMedicare PIN
NC11593OtherBCBS