Provider Demographics
NPI:1528047339
Name:POLISH, ROGER DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DAVID
Last Name:POLISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:66 CALLE SANTA CRUZ
Mailing Address - Street 2:INSTITUTO SAN PABLO, SUITE 502
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7041
Mailing Address - Country:US
Mailing Address - Phone:787-778-0632
Mailing Address - Fax:787-778-3720
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:INSTITUTO SAN PABLO, SUITE 502
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-778-0632
Practice Address - Fax:787-778-3720
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101055566207RG0100X
PR15803207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I-63398Medicare UPIN