Healthcare Provider Details

I. General information

NPI: 1841433885
Provider Name (Legal Business Name): POLAM & ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FREEPORT RD STE 200
BLAWNOX PA
15238-3485
US

IV. Provider business mailing address

121 FREEPORT RD STE 200
BLAWNOX PA
15238-3485
US

V. Phone/Fax

Practice location:
  • Phone: 412-784-7180
  • Fax: 412-784-7185
Mailing address:
  • Phone: 412-784-7180
  • Fax: 412-784-7185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number038348L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number038348L
License Number StatePA

VIII. Authorized Official

Name: DR. CHANDRA R POLAM
Title or Position: OWNER
Credential: MD
Phone: 412-784-7180