Provider Demographics
NPI:1356990584
Name:POLINGER, MAAYAN MAIA ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:MAAYAN
Middle Name:MAIA ROSE
Last Name:POLINGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAAYAN MAIA
Other - Middle Name:ROSE
Other - Last Name:POLINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10705 NELLE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3938
Mailing Address - Country:US
Mailing Address - Phone:505-470-3103
Mailing Address - Fax:
Practice Address - Street 1:6801 JEFFERSON ST NE STE 350
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4361
Practice Address - Country:US
Practice Address - Phone:505-847-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2019-0100207VG0400X, 363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology