Active NPI
Mark J Polis, M.D.
- Urology Physician
- Port Matilda, PA
National Provider Identifier
1548373939
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- MD028607E
- Practice address
- 240 Montauk Cir
Port Matilda, PA 16870-7314 - Phone
- (814) 867-3953
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Urology Physician | 208800000X | MD028607E | PA | Primary |
Addresses
Primary practice location
240 Montauk Cir
Port Matilda, PA 16870-7314
Mailing address
240 Montauk Cir
Port Matilda, PA 16870-7314
Phone (814) 867-3953
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD028607E | PA | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347840000000",
"number": "1548373939",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 MONTAUK CIR",
"city": "PORT MATILDA",
"state": "PA",
"postal_code": "168707314",
"telephone_number": "814-867-3953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 MONTAUK CIR",
"city": "PORT MATILDA",
"state": "PA",
"postal_code": "168707314",
"telephone_number": "814-867-3953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLIS",
"first_name": "MARK",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-17",
"last_updated": "2012-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "PA",
"license": "MD028607E",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Matilda, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.