Provider Demographics
NPI:1689261778
Name:POLCE, STEPHANIE RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEE
Last Name:POLCE
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 1:504 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:TURTLE CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:15145-1522
Mailing Address - Country:US
Mailing Address - Phone:412-496-8206
Mailing Address - Fax:
Practice Address - Street 1:12547 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9689
Practice Address - Country:US
Practice Address - Phone:410-213-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007842363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0007842OtherMEDICAL