=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205811494
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RODOLFO S POLINTAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2005
-----------------------------------------------------
Last Update Date | 04/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 807 TURNPIKE AVE SUITE 120
-----------------------------------------------------
City | CLEARFIELD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16830-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-765-8590
-----------------------------------------------------
Fax | 814-765-5058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 809 TURNPIKE AVE
-----------------------------------------------------
City | CLEARFIELD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16830-1232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-768-2356
-----------------------------------------------------
Fax | 814-768-2134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MD022179E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XP3100X
-----------------------------------------------------
Taxonomy Name | Pediatric Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MD022179E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------