Provider Demographics
NPI:1699756544
Name:POLAKOVSKY, DEEANN MAE (PAC)
Entity type:Individual
Prefix:MRS
First Name:DEEANN
Middle Name:MAE
Last Name:POLAKOVSKY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:DEANN
Other - Middle Name:MAE
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:6321 ROUTE 30 FL 2
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-9703
Mailing Address - Country:US
Mailing Address - Phone:724-671-1570
Mailing Address - Fax:724-522-7726
Practice Address - Street 1:6321 ROUTE 30 FL 2
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-9703
Practice Address - Country:US
Practice Address - Phone:724-671-1570
Practice Address - Fax:724-522-7726
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003596L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12684515OtherCAQH
062880H2TMedicare ID - Type Unspecified