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Individual

DR. GARY I POLYKOFF

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
15 PARKMAN ST, WAC 340 ANESTHESIA PAIN MANAGEMENT, BOSTON, MA 02114-3117
(617) 726-3512
(617) 726-3519
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
81894
MA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
81894
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
081894
TUFTS HEALTH PLAN
MA
05
3186733
MA
01
J19417
BCBS MA
MA
Enumeration date
10/27/2005
Last updated
09/22/2011
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