Provider Demographics
NPI:1124025952
Name:POGODZINSKI, CHRISTOPHER MARK (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:POGODZINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4059 JANDY BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8893
Mailing Address - Country:US
Mailing Address - Phone:484-503-6450
Mailing Address - Fax:484-503-6445
Practice Address - Street 1:4059 JANDY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8893
Practice Address - Country:US
Practice Address - Phone:484-503-6450
Practice Address - Fax:484-503-6445
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066347L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1748150Medicaid
PA1748150Medicaid
G92196Medicare UPIN