Provider Demographics
NPI:1588639710
Name:PODOLSKY, WILLIAM J (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
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:PO BOX 756
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526
Mailing Address - Country:US
Mailing Address - Phone:209-543-0684
Mailing Address - Fax:209-343-3809
Practice Address - Street 1:7887 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-437-1000
Practice Address - Fax:559-437-3870
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG347102085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG347100Medicaid
CAOOG347100Medicare ID - Type Unspecified
CAOOG347100Medicaid