Provider Demographics
NPI:1326274697
Name:POLSON, MARK ALAN (CSA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:POLSON
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8716 BARNETT ST
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4914
Mailing Address - Country:US
Mailing Address - Phone:703-369-1117
Mailing Address - Fax:
Practice Address - Street 1:8716 BARNETT ST
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4914
Practice Address - Country:US
Practice Address - Phone:703-369-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical