Provider Demographics
NPI:1609937606
Name:POLISHOOK, ROBERT D (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:POLISHOOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 HEATH RD
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1422
Mailing Address - Country:US
Mailing Address - Phone:610-667-1177
Mailing Address - Fax:
Practice Address - Street 1:563 HEATH RD
Practice Address - Street 2:
Practice Address - City:MERION STATION
Practice Address - State:PA
Practice Address - Zip Code:19066-1422
Practice Address - Country:US
Practice Address - Phone:610-667-5435
Practice Address - Fax:610-667-1177
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-010201-E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA114502KKBOtherPIN
PAMD010201-EOtherLICENSE NO.
PAMD010201-EOtherLICENSE NO.
PAC30527Medicare UPIN