Provider Demographics
NPI:1881697886
Name:POLUN, FRANKLIN RANDALL (DPM)
Entity type:Individual
Prefix:DR
First Name:FRANKLIN
Middle Name:RANDALL
Last Name:POLUN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12400 PARK POTOMAC AVE # R2
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-6973
Mailing Address - Country:US
Mailing Address - Phone:301-983-8202
Mailing Address - Fax:877-810-5148
Practice Address - Street 1:12400 PARK POTOMAC AVE # R2
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-6973
Practice Address - Country:US
Practice Address - Phone:301-983-8202
Practice Address - Fax:301-299-3985
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-11-02
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MD00941213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD197590N56Medicare PIN
MD619856Medicare PIN
T31059Medicare UPIN
DC480022882Medicare PIN