Provider Demographics
NPI:1326662396
Name:PODOLSKY, DALE JUSTIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:JUSTIN
Last Name:PODOLSKY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SAND POINT WAY NE, OB.9.520, SEATTLE CHILDREN'S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-987-3256
Mailing Address - Fax:206-987-3064
Practice Address - Street 1:4800 SAND POINT WAY NE, OB.9.520, SEATTLE CHILDREN'S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-987-3256
Practice Address - Fax:206-987-3064
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program