Provider Demographics
NPI:1497103667
Name:VAN DEN BERG, POLLY HENRICA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:POLLY
Middle Name:HENRICA MARIA
Last Name:VAN DEN BERG
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Gender:F
Credentials:MD
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Mailing Address - Street 1:301 S. 8TH STREET
Mailing Address - Street 2:STE 1B, DUNCAN BLDG
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4015
Mailing Address - Country:US
Mailing Address - Phone:215-829-5354
Mailing Address - Fax:215-829-7132
Practice Address - Street 1:301 S. 8TH STREET
Practice Address - Street 2:STE. 1B, DUNCAN BLDG
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4015
Practice Address - Country:US
Practice Address - Phone:215-829-5354
Practice Address - Fax:215-829-7132
Is Sole Proprietor?:No
Enumeration Date:2016-05-29
Last Update Date:2021-08-23
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Provider Licenses
StateLicense IDTaxonomies
PAMD473856207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease