Provider Demographics
NPI:1376502823
Name:PODRASKY, ERNEST J (MD)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:J
Last Name:PODRASKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-773-9992
Mailing Address - Fax:603-778-6393
Practice Address - Street 1:3 ALUMNI DR STE 101
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2122
Practice Address - Country:US
Practice Address - Phone:603-772-9992
Practice Address - Fax:603-778-6393
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14092207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076042Medicaid
KS104614OtherBCBS KANSAS
NH30207965Medicaid
KS104614Medicare ID - Type UnspecifiedINDIVIDUAL ID
NH000777601Medicare PIN
KS104614OtherBCBS KANSAS
KSI28448Medicare UPIN
KS200327550AMedicaid