MEDICARE: POLINA STOLYAROVA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD418065	PA

General Provider Information

NPI Number	:	1043228216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POLINA STOLYAROVA M.D.

Provider Business Mailing Address
First Line	:	10151 BUSTLETON AVE
Second Line	:	UNIT C
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3718
Country	:	US
Telephone Number	:	215-676-6393
Fax Number	:	215-676-6395

Provider Business Practice Location Address
First Line	:	10151 BUSTLETON AVE
Second Line	:	UNIT C
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3718
Country	:	US
Telephone Number	:	215-676-6393
Fax Number	:	215-676-6395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	02/14/2013

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