Provider Demographics
NPI:1205851581
Name:PODOSEK, ALAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:PODOSEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2217 SURREY PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-3041
Mailing Address - Country:US
Mailing Address - Phone:434-384-3273
Mailing Address - Fax:
Practice Address - Street 1:113 WIGGINGTON RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4619
Practice Address - Country:US
Practice Address - Phone:434-385-7578
Practice Address - Fax:434-385-9756
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024093208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5990008OtherAETNA
VA012828OtherANTHEM BCBS
VA5674808Medicaid
VA012828OtherANTHEM BCBS