Provider Demographics
NPI:1083739510
Name:POLONIO, VIRGILIO ARITIDY (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGILIO
Middle Name:ARITIDY
Last Name:POLONIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0543
Mailing Address - Country:US
Mailing Address - Phone:787-836-3409
Mailing Address - Fax:787-836-2176
Practice Address - Street 1:PEDRO VELAZQUEZ DIAZ 628 SUITE A 4
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-928-7141
Practice Address - Fax:787-709-4687
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10424208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41791Medicare UPIN
PR8-3038Medicare ID - Type UnspecifiedPROVIDER ID