Provider Demographics
NPI:1083965388
Name:PODDAR, CLIFFORD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:
Last Name:PODDAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8915 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3639
Mailing Address - Country:US
Mailing Address - Phone:240-286-4465
Mailing Address - Fax:
Practice Address - Street 1:19785 CRYSTAL ROCK DR
Practice Address - Street 2:SUITE 209
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-4700
Practice Address - Country:US
Practice Address - Phone:301-515-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004671363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical