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NPI Code Detail

MEDICARE: DR. POLINA SEMENOVNA VASSILIEVA MD

MEDICARE: DR. POLINA SEMENOVNA VASSILIEVA 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
12084P0800XPsychiatry PhysicianMD420499PA

General Provider Information

NPI Number : 1972617553
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. POLINA SEMENOVNA VASSILIEVA MD
Provider Business Mailing Address
First Line : 100 SHENANGO AVE
Second Line :
City : SHARON
State : PA
Zip : 16146-1503
Country : US
Telephone Number : 724-770-9095
Fax Number : 724-770-9096
Provider Business Practice Location Address
First Line : 176 VIRGINIA AVE
Second Line :
City : ROCHESTER
State : PA
Zip : 15074-1723
Country : US
Telephone Number : 724-770-9095
Fax Number : 724-770-9096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 07/21/2022

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