Healthcare Provider Details

I. General information

NPI: 1821201260
Provider Name (Legal Business Name): R.S.POLINTAN,M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 TURNPIKE AVE SUITE 120
CLEARFIELD PA
16830-1238
US

IV. Provider business mailing address

807 TURNPIKE AVE SUITE 120
CLEARFIELD PA
16830-1238
US

V. Phone/Fax

Practice location:
  • Phone: 814-765-8590
  • Fax: 814-765-5058
Mailing address:
  • Phone: 814-765-8590
  • Fax: 814-765-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD022179E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0006788840001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: RODOLFO S POLINTAN
Title or Position: MD
Credential:
Phone: 814-765-8590