Provider Demographics
NPI:1043228216
Name:STOLYAROVA, POLINA (MD)
Entity type:Individual
Prefix:
First Name:POLINA
Middle Name:
Last Name:STOLYAROVA
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 1:10151 BUSTLETON AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3718
Mailing Address - Country:US
Mailing Address - Phone:215-676-6393
Mailing Address - Fax:215-676-6395
Practice Address - Street 1:10151 BUSTLETON AVE
Practice Address - Street 2:UNIT C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3718
Practice Address - Country:US
Practice Address - Phone:215-676-6393
Practice Address - Fax:215-676-6395
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4180652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry