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General NPI Number Information
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NPI Number | 1730201872
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Entity Type | Organization
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Legal Business Name | MARK S. POLIN, MD
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 445 WYOMING AVE
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City | KINGSTON
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State | PA
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Zip | 18704-3601
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Country | US
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Telephone | 570-714-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 445 WYOMING AVE
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City | KINGSTON
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State | PA
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Zip | 18704
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Country | US
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Telephone | 570-714-2300
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MARK S. POLIN
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Credential |
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Telephone | 570-714-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD040967E
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License Number State | PA
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