Provider Demographics
NPI:1710933197
Name:POLATTY, ROSE CRYSTAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:CRYSTAL
Last Name:POLATTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:403 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6839
Mailing Address - Country:US
Mailing Address - Phone:804-285-7422
Mailing Address - Fax:804-675-5319
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:161
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5756
Practice Address - Fax:804-675-5319
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101030189207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine