Provider Demographics
NPI:1588683650
Name:POLLEY, WILLIAM EMORY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EMORY
Last Name:POLLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3094 W MARKET ST STE 345
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3634
Mailing Address - Country:US
Mailing Address - Phone:330-867-1205
Mailing Address - Fax:330-867-1259
Practice Address - Street 1:3094 W MARKET ST STE 345
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3634
Practice Address - Country:US
Practice Address - Phone:330-867-1205
Practice Address - Fax:330-867-1259
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35038705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0335293Medicaid
OHA76115Medicare UPIN
OHPO0434481Medicare ID - Type Unspecified