Provider Demographics
NPI:1295227460
Name:POLY, FAHMIDA (MD)
Entity Type:Individual
Prefix:
First Name:FAHMIDA
Middle Name:
Last Name:POLY
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 1:4106 PORTSMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2968
Mailing Address - Country:US
Mailing Address - Phone:757-393-1136
Mailing Address - Fax:757-698-2499
Practice Address - Street 1:4106 PORTSMOUTH BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2968
Practice Address - Country:US
Practice Address - Phone:757-393-1136
Practice Address - Fax:757-698-2499
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101273387207Q00000X
PAMT215117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine