Provider Demographics
NPI:1023201589
Name:PODOLSKI, MARIELA (MD)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:PODOLSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIELA
Other - Middle Name:
Other - Last Name:ACUNA PAZOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:44 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-3718
Mailing Address - Country:US
Mailing Address - Phone:860-707-4880
Mailing Address - Fax:860-955-4804
Practice Address - Street 1:433 S MAIN ST STE 327
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2816
Practice Address - Country:US
Practice Address - Phone:860-410-4007
Practice Address - Fax:860-955-4804
Is Sole Proprietor?:No
Enumeration Date:2007-08-19
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2668692084P0800X, 2084P0804X
CT0506222084P0804X, 2084P0800X
CT82792084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004025177Medicaid
CT004041729Medicaid
CTD400107936Medicare PIN
CTD400076304Medicare PIN
CTD400076301Medicare PIN