Provider Demographics
NPI:1679640619
Name:POLANCO, ELADIO A (MD)
Entity Type:Individual
Prefix:
First Name:ELADIO
Middle Name:A
Last Name:POLANCO
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 1:704 CALLE CUPIDO
Mailing Address - Street 2:URB. VENUS GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4821
Mailing Address - Country:US
Mailing Address - Phone:787-283-1313
Mailing Address - Fax:
Practice Address - Street 1:704 CALLE CUPIDO
Practice Address - Street 2:URB. VENUS GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4821
Practice Address - Country:US
Practice Address - Phone:787-283-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4835170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics