MEDICARE: DR. STACEY POLAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS004495L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518997881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY POLAN D.O.

Provider Business Mailing Address
First Line	:	4 SNOWDEN RD
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2633
Country	:	US
Telephone Number	:	215-465-5607
Fax Number	:	215-465-6830

Provider Business Practice Location Address
First Line	:	152 WOLF ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19148-3325
Country	:	US
Telephone Number	:	215-465-5607
Fax Number	:	215-465-6830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

Similar Medicare Providers

1700887429 — MICHAEL A DELUCA PT
Practice Location Address:

2101 S COLUMBUS BLVD
PHILA, PA
19148-2805

Practice Phone: 215-467-4431
Practice Fax: 215-467-8879

1962404897 — BARRY ALAN BRAVETTE MD
Practice Location Address:

1703 S BROAD ST , SUITE 300
PHILA, PA
19148-1536

Practice Phone: 215-463-5333
Practice Fax: 215-463-8085

1922000868 — SALVATORE P GIRARDO MD
Practice Location Address:

1703 S BROAD ST , SUITE 300
PHILA, PA
19148-1536

Practice Phone: 215-463-5333
Practice Fax: 215-463-8085

1215939178 — WILLIAM BECKWITH MD
Practice Location Address:

1703 S BROAD ST , STE 300
PHILA, PA
19148-1536

Practice Phone: 215-462-7100
Practice Fax: 215-463-3820

1619947553 — VERONICA A COVALESKY MD
Practice Location Address:

1703 S BROAD ST , SUITE 300
PHILA, PA
19148

Practice Phone: 215-463-5333
Practice Fax: 215-463-8085

1710918149 — RENZI MEDICAL,PC
Practice Location Address:

1324 W RITNER ST , SUITE A
PHILA, PA
19148-3535

Practice Phone: 267-773-7311
Practice Fax: 267-773-7312

Directions to “ DR. STACEY POLAN D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.