Provider Demographics
NPI:1144037714
Name:POLING, QUENTIN MICHAEL (PA-S)
Entity type:Individual
Prefix:
First Name:QUENTIN
Middle Name:MICHAEL
Last Name:POLING
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3896 NEELY RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-2035
Mailing Address - Country:US
Mailing Address - Phone:941-402-3163
Mailing Address - Fax:
Practice Address - Street 1:3896 NEELY RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2035
Practice Address - Country:US
Practice Address - Phone:941-402-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program