Provider Demographics
NPI:1447380779
Name:POLIS, NICHOLAS GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:GEORGE
Last Name:POLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1426 ROSEWOOD HILL DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1484
Mailing Address - Country:US
Mailing Address - Phone:703-757-0242
Mailing Address - Fax:703-348-4127
Practice Address - Street 1:6200 OREGON AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1543
Practice Address - Country:US
Practice Address - Phone:202-541-0400
Practice Address - Fax:703-348-4127
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044882207R00000X
DCMD20177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
28180002OtherCAREFIRST BCBS
DC026071700Medicaid
28180002OtherCAREFIRST BCBS
F59164Medicare UPIN