Healthcare Provider Details

I. General information

NPI: 1417936048
Provider Name (Legal Business Name): SCOTT POLSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 2ND AVE NE
HICKORY NC
28601-5045
US

IV. Provider business mailing address

PO BOX 890273
CHARLOTTE NC
28289-0273
US

V. Phone/Fax

Practice location:
  • Phone: 828-328-2231
  • Fax: 828-323-1562
Mailing address:
  • Phone: 828-328-2231
  • Fax: 828-323-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number9700365
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9700365
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: