Healthcare Provider Details

I. General information

NPI: 1790300044
Provider Name (Legal Business Name): POLINA FERD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 03/11/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 SPRUCE ST DULLES BLDG., STE 680
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-349-8310
  • Fax: 215-662-2739
Mailing address:
  • Phone: 215-349-8310
  • Fax: 215-662-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD484133
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: