| Mark R Polak, DO | |
|
601 Childrens Ln, Norfolk, VA 23507-1910 | |
| (757) 668-7320 | |
| (757) 668-9735 |
| Full Name | Mark R Polak |
|---|---|
| Gender | Male |
| Speciality | Anesthesiology |
| Location | 601 Childrens Ln, Norfolk, Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356381412 | NPI | - | NPPES |
| 0000980903 | Medicaid | DE | |
| 005713668 | Medicaid | VA | |
| 732002700 | Medicaid | MD | |
| 9840896000 | Medicaid | WV | |
| 690567T | Medicaid | NC | |
| 0017337390001 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207L00000X | Anesthesiology | 0101050212 (Virginia) | Primary |
| Entity Name | Childrens Specialty Group Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1255354130 PECOS PAC ID: 5890788764 Enrollment ID: O20040406001195 |
| Mailing Address | Practice Location Address |
|---|---|
| Mark R Polak, DO Po Box 79137, Baltimore, MD 21279-0137 Ph: (757) 668-7200 | Mark R Polak, DO 601 Childrens Ln, Norfolk, VA 23507-1910 Ph: (757) 668-7320 |
Kenneth F. Tiffany, M.D. Anesthesiology Medicare: Medicare Enrolled Practice Location: 601 Childrens Ln, Norfolk, VA 23507 Phone: 757-668-7456 Fax: 757-668-9255 | |
Ross H Zoll, MD Anesthesiology Medicare: Medicare Enrolled Practice Location: 600 Gresham Dr, Norfolk, VA 23507 Phone: 757-668-3871 | |
Steven C Johnson, MD Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 600 Gresham Dr, Norfolk, VA 23507 Phone: 757-668-3871 | |
Dr. Valbona Kanarek, MD Anesthesiology Medicare: Medicare Enrolled Practice Location: 811 Redgate Ave, Norfolk, VA 23507 Phone: 757-668-7007 Fax: 757-668-8658 | |
Kelli A Petronis, M.D. Anesthesiology Medicare: Medicare Enrolled Practice Location: 601 Childrens Ln, Norfolk, VA 23507 Phone: 757-668-9222 Fax: 757-668-7568 | |
Allan E Stiner, MD Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 600 Gresham Dr, Norfolk, VA 23507 Phone: 757-668-3871 | |
Brian Shanklin Weaver, MD Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 814 Kempsville Rd, Suite 104, Norfolk, VA 23502 Phone: 757-455-8887 |