Provider Demographics
NPI:1598809543
Name:POLK, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:POLK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5480 WISCONSIN AVE
Mailing Address - Street 2:SUITE 421
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3530
Mailing Address - Country:US
Mailing Address - Phone:301-656-6446
Mailing Address - Fax:301-215-7615
Practice Address - Street 1:5480 WISCONSIN AVE
Practice Address - Street 2:SUITE 421
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3530
Practice Address - Country:US
Practice Address - Phone:301-656-6446
Practice Address - Fax:301-215-7615
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2010-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD00099322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC173226Medicare PIN
MDC62249Medicare UPIN