Individual
LIDIANNY POLANCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
850 PETER BRYCE BLVD, TUSCALOOSA, AL 35401-7457
(205) 348-1770
Mailing address
1 ELY PARK BLVD APT 56-2, BINGHAMTON, NY 13905-1447
(201) 401-7923
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO1984
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2016
Last updated
08/30/2019
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