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Individual

MARK R POLAK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-7320
(757) 668-9735
Mailing address
PO BOX 79137, BALTIMORE, MD 21279-0137
(757) 668-7200
(757) 668-9691

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0101050212
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0000980903
DE
05
0017337390001
PA
05
005713668
VA
05
690567T
NC
05
732002700
MD
05
9840896000
WV
Enumeration date
06/07/2006
Last updated
01/15/2010
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