Provider Demographics
NPI:1891037644
Name:POLINSKY, MARTIN SANDER (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:SANDER
Last Name:POLINSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 CALEDONIA ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1129
Mailing Address - Country:US
Mailing Address - Phone:215-482-0810
Mailing Address - Fax:
Practice Address - Street 1:953 CALEDONIA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1129
Practice Address - Country:US
Practice Address - Phone:215-482-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017431E2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology