Individual provider Active NPI

Charles Oluwarotimi Poluyi, M.D., M.P.H

  • Internal Medicine Physician
  • Wilkes Barre, PA
National Provider Identifier
1043990161
Registry record updated Jul 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD494684 Issued in PA
Practice address
1000 E Mountain Dr
Wilkes Barre, PA 18711-0027
Phone
(570) 808-7399
Fax
(570) 808-5942
NPI assigned
Jul 24, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD494684 PA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1000 E Mountain Dr
Wilkes Barre, PA 18711-0027

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 808-7399

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2010
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

100 N Academy Ave
Danville, PA 17822-4903

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782950400000",
    "number": "1043990161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-808-7399",
            "fax_number": "570-808-5942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E MOUNTAIN DR",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110027",
            "telephone_number": "570-808-7399",
            "fax_number": "570-808-5942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLUYI",
        "first_name": "CHARLES",
        "middle_name": "OLUWAROTIMI",
        "name_prefix": "Dr.",
        "credential": "M.D., M.P.H",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-24",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD494684",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

Verify at the official NPI Registry.