Individual
JOSE ROMAN POLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
31 ROCHE BROS WAY, NORTH EASTON, MA 02356-1032
(508) 894-8730
(508) 894-8732
Mailing address
39 BARTLETT AVE, CRANSTON, RI 02905-1334
(401) 529-3571
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
273647
MA
207R00000X
Internal Medicine Physician
MD10514
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110131381A
—
MA
05
—
7009048
—
RI
01
—
S400453494
MEDICARE
MA
Enumeration date
12/05/2005
Last updated
06/25/2020
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