Provider Demographics
NPI:1629152285
Name:POLANSKI, STANLEY JOSEPH (PA)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:JOSEPH
Last Name:POLANSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 LAKEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-6022
Mailing Address - Country:US
Mailing Address - Phone:828-349-0201
Mailing Address - Fax:
Practice Address - Street 1:1830 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-6778
Practice Address - Country:US
Practice Address - Phone:828-349-2081
Practice Address - Fax:828-524-6154
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P91010Medicare UPIN
2745499Medicare ID - Type Unspecified