Provider Demographics
NPI:1649214990
Name:PODDER, UTTAM (MD)
Entity Type:Individual
Prefix:
First Name:UTTAM
Middle Name:
Last Name:PODDER
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 1:100 CAPITOL COMMERCE BLVD
Mailing Address - Street 2:BLDG A SUITE 250
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4260
Mailing Address - Country:US
Mailing Address - Phone:334-358-3070
Mailing Address - Fax:334-358-3080
Practice Address - Street 1:4305 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-3101
Practice Address - Country:US
Practice Address - Phone:334-271-7051
Practice Address - Fax:334-271-7055
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009989205OtherALABAMA MEDICAID
GAH01629Medicare UPIN