Provider Demographics
NPI:1568404333
Name:POLING, JEFF (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:POLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 BEALL AVE
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2342
Mailing Address - Country:US
Mailing Address - Phone:330-263-8248
Mailing Address - Fax:330-263-8190
Practice Address - Street 1:1761 BEALL AVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2342
Practice Address - Country:US
Practice Address - Phone:330-263-8248
Practice Address - Fax:330-263-8190
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046789207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0471565Medicaid
OH4226124OtherAETNA
OH000000378938OtherANTHEM
OH732195OtherBUCKEYE COMMUNITY HEALTH
OHA80128Medicare UPIN
OHPO0500736Medicare ID - Type Unspecified