Basic Information
| Provider Information | |||||||||
| NPI: | 1295227460 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLY | ||||||||
| FirstName: | FAHMIDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1380 TUSCANY DR | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234567751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572529800 | ||||||||
| FaxNumber: | 7572759793 | ||||||||
| Practice Location | |||||||||
| Address1: | 1380 TUSCANY DR | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234567751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572529800 | ||||||||
| FaxNumber: | 7572759793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2018 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MT215117 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101273387 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.