Provider Demographics
NPI:1649215146
Name:PODNOS, YALE DAVID (MD)
Entity Type:Individual
Prefix:
First Name:YALE
Middle Name:DAVID
Last Name:PODNOS
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 1:1101 DRESSER CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7327
Mailing Address - Country:US
Mailing Address - Phone:919-876-2010
Mailing Address - Fax:919-954-0555
Practice Address - Street 1:1101 DRESSER CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7327
Practice Address - Country:US
Practice Address - Phone:919-876-2010
Practice Address - Fax:919-954-0555
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600500208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142KXOtherBCBS
NC5904099Medicaid
NC142KXOtherBCBS