Provider Demographics
NPI:1952540957
Name:POLCARO, KATHRYN MCCANN (PA)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MCCANN
Last Name:POLCARO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:9715 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 415
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3320
Mailing Address - Country:US
Mailing Address - Phone:301-340-9200
Mailing Address - Fax:301-279-9358
Practice Address - Street 1:9715 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 415
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3320
Practice Address - Country:US
Practice Address - Phone:301-340-9200
Practice Address - Fax:301-279-9358
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2022-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002971363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1952540957Medicaid
VA1952540957Medicaid