Provider Demographics
NPI:1285663187
Name:PODELL, ROSS D (MD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:D
Last Name:PODELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 WEST LANCASTER AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1751
Mailing Address - Country:US
Mailing Address - Phone:610-889-7530
Mailing Address - Fax:610-889-7531
Practice Address - Street 1:250 WEST LANCASTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1751
Practice Address - Country:US
Practice Address - Phone:610-889-7530
Practice Address - Fax:610-889-7531
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2014-07-17
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Provider Licenses
StateLicense IDTaxonomies
PAMD 066922L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA276714OtherHIGHMARK BLUE SHIELD
2008792001OtherKEYSTONE
261296OtherAETNA
PA0565534000OtherINDEPENDENCE BLUE CROSS
110227133OtherRR MCR
8118648004OtherCIGNA
133024OtherAETNA HMO
133024OtherAETNA HMO
G37819Medicare UPIN