Provider Demographics
NPI:1619098696
Name:WILLIAM J POGODA MD PA
Entity Type:Organization
Organization Name:WILLIAM J POGODA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:POGODA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-771-8080
Mailing Address - Street 1:9 SCHILLING ROAD
Mailing Address - Street 2:#LL3
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-8644
Mailing Address - Country:US
Mailing Address - Phone:410-771-8080
Mailing Address - Fax:410-771-8088
Practice Address - Street 1:9 SCHILLING ROAD
Practice Address - Street 2:#LL3
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-8644
Practice Address - Country:US
Practice Address - Phone:410-771-8080
Practice Address - Fax:410-771-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD761711900Medicaid
MD6556S612OtherINDIVIDUAL PTAN
MD761711900Medicaid
MD0780440001Medicare NSC
MD6556Medicare PIN