Provider Demographics
NPI:1184949042
Name:POLSKY, GAYLE COPELAND (MD)
Entity type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:COPELAND
Last Name:POLSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NEWPORT CENTER DR STE 380
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7613
Mailing Address - Country:US
Mailing Address - Phone:310-613-3469
Mailing Address - Fax:
Practice Address - Street 1:450 NEWPORT CENTER DR STE 380
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7613
Practice Address - Country:US
Practice Address - Phone:310-613-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1101332084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry