Provider Demographics
NPI:1558468264
Name:POLAKOVSKY, ANDREW G (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:G
Last Name:POLAKOVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1704
Mailing Address - Country:US
Mailing Address - Phone:724-887-3911
Mailing Address - Fax:724-887-0998
Practice Address - Street 1:310 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-1704
Practice Address - Country:US
Practice Address - Phone:724-887-3911
Practice Address - Fax:724-887-0998
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD055571L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000790051Medicaid
PA10934246OtherCAQH