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General NPI Number Information
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NPI Number | 1255128849
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Entity Type | Individual
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Provider Name | MARINA ESTHER POLANCO DE GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 55 MONUMENT RD
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City | YORK
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State | PA
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Zip | 17403-5023
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Country | US
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Telephone | 717-812-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 741 HAINES RD
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City | YORK
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State | PA
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Zip | 17402-3507
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Country | US
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Telephone | 347-520-6866
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | SP032756
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License Number State | PA
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