Provider Demographics
NPI:1902897887
Name:POLSTER, DANIEL S (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:POLSTER
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:PO BOX 638269
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2447
Mailing Address - Country:US
Mailing Address - Phone:440-816-5790
Mailing Address - Fax:
Practice Address - Street 1:7265 OLD OAK BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3342
Practice Address - Country:US
Practice Address - Phone:440-816-5790
Practice Address - Fax:440-816-5806
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350733422084P0800X
OH35.0733422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2161691Medicaid
OH2161691Medicaid
OHP04013411Medicare ID - Type Unspecified