Organization Active NPI

Pandolph & Polansky Family Practice PC

  • Family Medicine Physician
  • State College, PA
National Provider Identifier
1861455792
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PANDOLPH & POLANSKY FAMILY PRACTICE PC
Practice address
1528 Martin St
State College, PA 16803-3058
Phone
(814) 234-2007
NPI assigned
Apr 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephen J Pandolph, MD
Title
President
Phone
(814) 234-2007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1528 Martin St
State College, PA 16803-3058

Mailing address

1528 Martin St
State College, PA 16803-3058
Phone (814) 234-2007

National Provider Directory

National Provider Directory

Locations

1528 Martin St
State College, PA 16803
Phone (814) 234-2007

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1861455792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1528 MARTIN ST",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168033058",
            "telephone_number": "814-234-2007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 MARTIN ST",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168033058",
            "telephone_number": "814-234-2007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANDOLPH & POLANSKY FAMILY PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PANDOLPH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "814-234-2007",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.