Healthcare Provider Details

I. General information

NPI: 1871552232
Provider Name (Legal Business Name): CHANDRA R POLAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
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 Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMD038348L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD038348L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: