Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | MP0462933A | MA |
NPI | 1164409231 |
---|---|
Provider Name | Wojciech Poluha |
First Address | Worcester, MA 01605-2401 |
Second Address | Worcester, MA 01605-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 10/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0176303 | (05) | MA |
H54370 | (02) | MA |