Provider Demographics
NPI:1841433885
Name:POLAM & ASSOCIATES, PC
Entity type:Organization
Organization Name:POLAM & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:POLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-784-7180
Mailing Address - Street 1:121 FREEPORT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BLAWNOX
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3485
Mailing Address - Country:US
Mailing Address - Phone:412-784-7180
Mailing Address - Fax:412-784-7185
Practice Address - Street 1:121 FREEPORT RD STE 200
Practice Address - Street 2:
Practice Address - City:BLAWNOX
Practice Address - State:PA
Practice Address - Zip Code:15238-3485
Practice Address - Country:US
Practice Address - Phone:412-784-7180
Practice Address - Fax:412-784-7185
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POLAM & ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-07
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA038348L207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000915209004Medicaid
PA0009152090004Medicaid
PAPO464345OtherBLUE SHIELD
PAD71034Medicare UPIN