Provider Demographics
NPI:1114983970
Name:POLIAKOVA, MARINA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:POLIAKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9313 LARIMAR DR
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-5249
Mailing Address - Country:US
Mailing Address - Phone:216-862-8063
Mailing Address - Fax:
Practice Address - Street 1:6803 MAYFIELD RD
Practice Address - Street 2:SUITE 403
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2271
Practice Address - Country:US
Practice Address - Phone:440-312-1969
Practice Address - Fax:440-312-1969
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3867949Medicaid
OH2747237Medicaid
H46366Medicare UPIN
OH4203633Medicare PIN
OH2747237Medicaid