Provider Demographics
NPI:1821195538
Name:ANDREW POLAKOVSKY, MD, PC
Entity Type:Organization
Organization Name:ANDREW POLAKOVSKY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:G
Authorized Official - Last Name:POLOKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-887-3911
Mailing Address - Street 1:310 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1704
Mailing Address - Country:US
Mailing Address - Phone:724-887-3911
Mailing Address - Fax:724-887-0998
Practice Address - Street 1:310 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-1704
Practice Address - Country:US
Practice Address - Phone:724-887-3911
Practice Address - Fax:724-887-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA089890Medicare ID - Type Unspecified