Individual
KENNETH D POLIVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2000 WASHINGTON ST, SUITE 341, NEWTON, MA 02462-1650
(617) 964-0024
(617) 964-6374
Mailing address
2000 WASHINGTON ST, SUITE 341, NEWTON, MA 02462-1650
(617) 964-0024
(617) 964-6374
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
47345
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
047345
TUFTS
MA
01
—
17266
HARVARD PILGRIM
MA
05
—
6183484
—
MA
01
—
J03453
BCBS
MA
Enumeration date
03/14/2006
Last updated
11/01/2011
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