Provider Demographics
NPI:1780645176
Name:POLANSKY, ANDREW D (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:POLANSKY
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:PO BOX 462750
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92046-2750
Mailing Address - Country:US
Mailing Address - Phone:760-520-8500
Mailing Address - Fax:760-520-8523
Practice Address - Street 1:488 E VALLEY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3363
Practice Address - Country:US
Practice Address - Phone:760-739-5400
Practice Address - Fax:760-739-8471
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG454682085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G454680Medicaid
CAWG45468AMedicare PIN
A50054Medicare UPIN
CAWG45468HMedicare PIN
CAWG45468CMedicare PIN
CAWG45468FMedicare PIN
CAWG45468GMedicare PIN
CAWG45468BMedicare PIN