Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35082174P | OH |
NPI | 1053341602 |
---|---|
Provider Name | Amy M Polster |
First Address | Mayfield Heights, OH 44124-6510 |
Second Address | Hudson, OH 44236-4454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 11/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2384281 | (05) | OH |