Healthcare Provider Details

I. General information

NPI: 1477549368
Provider Name (Legal Business Name): KAREN JEAN POLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 NEVINS ST. STE 407
BRIGHTON MA
02135
US

IV. Provider business mailing address

77 WARREN ST RM 339
BROOKLINE MA
02135
US

V. Phone/Fax

Practice location:
  • Phone: 617-783-0095
  • Fax: 617-783-4460
Mailing address:
  • Phone: 617-562-5359
  • Fax: 617-562-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number156685
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number156685
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: