Healthcare Provider Details

I. General information

NPI: 1588760011
Provider Name (Legal Business Name): DAVID G POLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N POINTE BLVD
LANCASTER PA
17601-4132
US

IV. Provider business mailing address

595 NORWOOD PL
LANDISVILLE PA
17538-1538
US

V. Phone/Fax

Practice location:
  • Phone: 717-299-4871
  • Fax:
Mailing address:
  • Phone: 717-575-7378
  • Fax: 844-516-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD037864E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD037864E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD-037864-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: