Basic Information
| Provider Information | |||||||||
| NPI: | 1598716920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLCARO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 S NEW BALLAS RD STE 2007B | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631418265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149915000 | ||||||||
| FaxNumber: | 3149915035 | ||||||||
| Practice Location | |||||||||
| Address1: | 1031 BELLEVUE AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149777455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0102206718 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 25MB05676400 | NJ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 2016017358 | MO | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | 2016017358 | MO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8878102 | 05 | NJ | MEDICAID |