Provider Demographics
NPI:1710134796
Name:PANITZ, POLLY JANE (MD)
Entity Type:Individual
Prefix:MS
First Name:POLLY
Middle Name:JANE
Last Name:PANITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12950 HIGHLAND CROSSING DRIVE
Mailing Address - Street 2:STE. H
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171
Mailing Address - Country:US
Mailing Address - Phone:703-860-4200
Mailing Address - Fax:703-860-1528
Practice Address - Street 1:12950 HIGHLAND CROSSING DRIVE
Practice Address - Street 2:STE. H
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171
Practice Address - Country:US
Practice Address - Phone:703-860-4200
Practice Address - Fax:703-860-1528
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101050173208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics