Provider Demographics
NPI:1205926565
Name:POLONSKY, MONTY BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:MONTY
Middle Name:BRIAN
Last Name:POLONSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7606
Mailing Address - Country:US
Mailing Address - Phone:626-446-4461
Mailing Address - Fax:626-445-0647
Practice Address - Street 1:622 W DUARTE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7606
Practice Address - Country:US
Practice Address - Phone:626-446-4461
Practice Address - Fax:626-445-0647
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62039207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB236677OtherMEDICARE GR ID
CAG62039OtherSTATE MEDICAL LICENSE
CACB236677OtherMEDICARE GR ID
CAW2154Medicare ID - Type UnspecifiedMEDICARE GR ID
CAYYY48961YOtherBLUE SHIELD OF CALIF