Provider Demographics
NPI:1992913750
Name:POLING, BRIAN MATTHEW
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:MATTHEW
Last Name:POLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 JACOBY RD
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-2520
Mailing Address - Country:US
Mailing Address - Phone:330-329-9466
Mailing Address - Fax:
Practice Address - Street 1:2277 JACOBY RD
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-2520
Practice Address - Country:US
Practice Address - Phone:330-329-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRQ441885163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health