Provider Demographics
NPI:1083683635
Name:POLSTER, DAVID FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FREDERICK
Last Name:POLSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4515 CALAVO DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-5701
Mailing Address - Country:US
Mailing Address - Phone:619-940-5864
Mailing Address - Fax:619-462-3363
Practice Address - Street 1:VOLUNTEERS IN MEDICINE SAN DIEGO
Practice Address - Street 2:1457 W MADISON AVE
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1002
Practice Address - Country:US
Practice Address - Phone:619-440-4591
Practice Address - Fax:619-440-4944
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27435207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G274350Medicaid
WG27435BMedicare ID - Type Unspecified
CAA43353Medicare UPIN