Provider Demographics
NPI:1043217896
Name:PODOLSKY, EUGENE D (DPM)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:D
Last Name:PODOLSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:720 YOUNGSTOWN WARREN RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-3551
Practice Address - Country:US
Practice Address - Phone:330-652-0535
Practice Address - Fax:330-652-0536
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3600-2212213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2104005-000Medicaid
OH4080718Medicaid
OH0628593Medicaid
OH4080981Medicare ID - Type Unspecified
OH4080711Medicare ID - Type Unspecified
OH4080983Medicare ID - Type Unspecified
OH4080985Medicare ID - Type Unspecified
OH4080712Medicare ID - Type Unspecified
OH4080986Medicare ID - Type Unspecified
OH4080984Medicare ID - Type Unspecified
OH4080719Medicare ID - Type Unspecified
OH4080718Medicaid
OH0628593Medicaid
OH0577388Medicare ID - Type Unspecified
OH0577389Medicare ID - Type Unspecified
OH4080716Medicare ID - Type Unspecified
OH4080714Medicare ID - Type Unspecified
OH4080717Medicare ID - Type Unspecified
OH4080982Medicare ID - Type Unspecified