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NPI Code Detail

MEDICARE: WOJCIECH POLUHA MD

MEDICARE: WOJCIECH POLUHA MD
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
1207RA0401XAddiction Medicine (Internal Medicine) PhysicianMP0462933AMA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164409231
Entity Type Code : Individual
Provider Name (Legal Business Name) : WOJCIECH POLUHA MD
Provider Business Mailing Address
First Line : 107 LINCOLN ST
Second Line :
City : WORCESTER
State : MA
Zip : 01605-2401
Country : US
Telephone Number : 508-799-9000
Fax Number : 508-453-3107
Provider Business Practice Location Address
First Line : 107 LINCOLN ST
Second Line :
City : WORCESTER
State : MA
Zip : 01605-2401
Country : US
Telephone Number : 508-799-9000
Fax Number : 508-453-3107
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 12/10/2009

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Directions to “ WOJCIECH POLUHA MD” Practice Location

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