Active NPI
Tracy Polesovsky, OMT, RMT
- Dental Hygienist
- Parkton, MD
National Provider Identifier
1184450686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 4753
- Practice address
- 17026 York Rd
Parkton, MD 21120-9719 - Phone
- (410) 499-9288
- NPI assigned
- Sep 11, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 4753 | MD | Primary |
Addresses
Primary practice location
17026 York Rd
Parkton, MD 21120-9719
Mailing address
16918 Daisy Dell CT
Monkton, MD 21111-1094
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4753 | MD | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726012800000",
"number": "1184450686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16918 DAISY DELL CT",
"city": "MONKTON",
"state": "MD",
"postal_code": "211111094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17026 YORK RD",
"city": "PARKTON",
"state": "MD",
"postal_code": "211209719",
"telephone_number": "410-499-9288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLESOVSKY",
"first_name": "TRACY",
"credential": "OMT, RMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-09-11",
"last_updated": "2024-09-11",
"certification_date": "2024-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MD",
"license": "4753",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Parkton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.