Provider Demographics
NPI:1003812272
Name:PODOLNY, GARY A (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:PODOLNY
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 1:13305 E SADDLEROCK RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9296
Mailing Address - Country:US
Mailing Address - Phone:520-749-3468
Mailing Address - Fax:
Practice Address - Street 1:13305 E SADDLEROCK RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9296
Practice Address - Country:US
Practice Address - Phone:520-749-3468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ352092085R0202X, 2085U0001X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1003812272OtherPHYSICIAN INDIVIDUAL NPI
AZ005472OtherGROUP MEDICAID ID
AZ133383Medicaid
AZ1841261989OtherGROUP NPI
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN
AZZWCBBMOtherGROUP MEDICARE ID
AZP00358695OtherMEDICARE RAILROAD
AZ1841261989OtherGROUP NPI
AZCS7943OtherGROUP MEDICARE RAILROAD ID & PTAN