Basic Information
| Provider Information | |||||||||
| NPI: | 1417995853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLITO | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 ST. PAUL PLACE | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212022102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106592802 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 SAINT PAUL PL | ||||||||
| Address2: | TOWER - 4TH FLOOR | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212022102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103329732 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 03/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | D51021 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 680601500 | 05 | MD | MEDICAID |