Provider Demographics
NPI:1073624425
Name:PODRASKY, DAVID F (M D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:PODRASKY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 637273
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7273
Mailing Address - Country:US
Mailing Address - Phone:812-842-4200
Mailing Address - Fax:812-842-4226
Practice Address - Street 1:4199 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8940
Practice Address - Country:US
Practice Address - Phone:812-842-4200
Practice Address - Fax:812-842-4227
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064306A207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000544281OtherBLUE CROSS BLUE SHIELD
IN200871730Medicaid
B31361Medicare UPIN
IN200871730AMedicaid
IN1265636021OtherGROUP NPI
IN200871730AMedicaid