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General NPI Number Information
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NPI Number | 1871552232
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Entity Type | Individual
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Provider Name | CHANDRA R POLAM MD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 121 FREEPORT RD STE 200
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City | BLAWNOX
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State | PA
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Zip | 15238-3485
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Country | US
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Telephone | 412-784-7180
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Fax | 412-784-7185
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Provider Business Mailing Address
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Address Line | 121 FREEPORT RD STE 200
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City | BLAWNOX
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State | PA
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Zip | 15238-3485
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Country | US
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Telephone | 412-784-7180
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Fax | 412-784-7185
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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 | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | MD038348L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD038348L
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License Number State | PA
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