Provider Demographics
NPI:1649234840
Name:POLKE, DAVID JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:POLKE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:133 SCOVILL ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1127
Mailing Address - Country:US
Mailing Address - Phone:203-575-1811
Mailing Address - Fax:203-575-1995
Practice Address - Street 1:133 SCOVILL ST
Practice Address - Street 2:SUITE 303
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1127
Practice Address - Country:US
Practice Address - Phone:203-575-1811
Practice Address - Fax:203-575-1995
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT029220207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE57416Medicare UPIN