Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD022179E | PA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD022179E | PA |
NPI | 1205811494 |
---|---|
Provider Name | Dr. Rodolfo S Polintan |
First Address | Clearfield, PA 16830-1232 |
Second Address | Clearfield, PA 16830-1238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 26/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105747 | BLUE CROSS/BLUE SHIELD (01) | PA |
18081 | GEISINGER (01) | PA |
211174 | UPMC (01) | PA |
B36647 | (02) | PA |