Provider Demographics
NPI:1942537725
Name:POLAN, ERIK GEORGE (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:GEORGE
Last Name:POLAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4190 CITY AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1626
Mailing Address - Country:US
Mailing Address - Phone:215-871-6337
Mailing Address - Fax:215-871-6347
Practice Address - Street 1:4190 CITY AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1626
Practice Address - Country:US
Practice Address - Phone:215-871-6337
Practice Address - Fax:215-871-6347
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012185207R00000X
PAOS015176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA186331Medicare PIN