Provider Demographics
NPI:1174891402
Name:POLAKOSKI, THERESE (PA-C)
Entity type:Individual
Prefix:MS
First Name:THERESE
Middle Name:
Last Name:POLAKOSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 N EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3309
Mailing Address - Country:US
Mailing Address - Phone:412-415-0061
Mailing Address - Fax:
Practice Address - Street 1:4401 PENN AVE
Practice Address - Street 2:FACULTY PAVILION, FLOOR 5
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1334
Practice Address - Country:US
Practice Address - Phone:412-692-6064
Practice Address - Fax:412-692-6991
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055050363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant