Provider Demographics
NPI:1801095906
Name:INKOULOVA, POLINA (MD)
Entity type:Individual
Prefix:DR
First Name:POLINA
Middle Name:
Last Name:INKOULOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2589
Mailing Address - Country:US
Mailing Address - Phone:603-609-6925
Mailing Address - Fax:603-740-2460
Practice Address - Street 1:801 CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2529
Practice Address - Country:US
Practice Address - Phone:603-740-9713
Practice Address - Fax:603-740-2447
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19283207RC0200X
ME017697207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3095935Medicaid