MEDICARE: ANDREW K POLLA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	17621	NY
2	363AM0700X	Medical Physician Assistant	017621	NY

General Provider Information

NPI Number	:	1124436779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW K POLLA PA-C

Provider Business Mailing Address
First Line	:	601 ELMWOOD AVE BOX 655
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14642-8655
Country	:	US
Telephone Number	:	585-273-4398
Fax Number	:

Provider Business Practice Location Address
First Line	:	2047 W RIDGE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2718
Country	:	US
Telephone Number	:	585-276-9100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	06/29/2023

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