Provider Demographics
NPI:1306161542
Name:WILLIAM J POLK, MD,PA
Entity type:Organization
Organization Name:WILLIAM J POLK, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-656-6446
Mailing Address - Street 1:5480 WISCONSIN AVE
Mailing Address - Street 2:SUITE 421
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3530
Mailing Address - Country:US
Mailing Address - Phone:301-656-6644
Mailing Address - Fax:301-215-7615
Practice Address - Street 1:5480 WISCONSIN AVE
Practice Address - Street 2:SUITE 421
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3530
Practice Address - Country:US
Practice Address - Phone:301-656-6644
Practice Address - Fax:301-215-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
173226Medicare UPIN