Provider Demographics
NPI:1477553717
Name:POLK, WILLIAM H (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:POLK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8777
Mailing Address - Fax:757-232-8866
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4430
Practice Address - Country:US
Practice Address - Phone:757-877-4221
Practice Address - Fax:757-886-1042
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2013-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101032429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110182932OtherRR/MEDICARE
VA104083OtherANTHEM
VA6001611Medicaid
VAB08339Medicare UPIN
110182932OtherRR/MEDICARE