Provider Demographics
NPI:1326737537
Name:CREVELING, POLLY (MD)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:CREVELING
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 1:101 MANNING DR.
Mailing Address - Street 2:DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:984-974-1000
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR.
Practice Address - Street 2:DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:984-974-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCREV-LXP9YG390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program