Provider Demographics
NPI:1568556348
Name:ROST, POLLY M (PHD)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:M
Last Name:ROST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3158
Mailing Address - Country:US
Mailing Address - Phone:717-843-6561
Mailing Address - Fax:717-845-6941
Practice Address - Street 1:807 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3158
Practice Address - Country:US
Practice Address - Phone:717-843-6561
Practice Address - Fax:717-845-6941
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS4615L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA108336Medicare UPIN