Provider Demographics
NPI:1366408577
Name:TERRY E PODELL MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TERRY E PODELL MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PODELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-528-1020
Mailing Address - Street 1:16133 VENTURA BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2429
Mailing Address - Country:US
Mailing Address - Phone:818-528-1020
Mailing Address - Fax:818-528-1021
Practice Address - Street 1:16133 VENTURA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2429
Practice Address - Country:US
Practice Address - Phone:818-528-1020
Practice Address - Fax:818-528-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19603Medicare ID - Type Unspecified