Provider Demographics
NPI:1629017629
Name:POLI, KIM ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:ANN
Last Name:POLI
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Gender:F
Credentials:MD
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Mailing Address - Street 1:47 NEW SCOTLAND AVE
Mailing Address - Street 2:MC-44
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:518-262-5082
Mailing Address - Fax:518-262-5082
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:MC-44
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-5768
Practice Address - Fax:518-262-5082
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2010-06-22
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Provider Licenses
StateLicense IDTaxonomies
MA80926207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY060063919OtherRR MEDICARE
NY2026756306204Medicaid
NY2026756306204Medicaid
NY060063919OtherRR MEDICARE