Provider Demographics
NPI:1891729042
Name:PODELL, RONALD MARK (MD,)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MARK
Last Name:PODELL
Suffix:
Gender:M
Credentials:MD,
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Mailing Address - Street 1:11835 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 220 EAST
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-5001
Mailing Address - Country:US
Mailing Address - Phone:310-312-1013
Mailing Address - Fax:310-312-1014
Practice Address - Street 1:11835 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 220 EAST
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5001
Practice Address - Country:US
Practice Address - Phone:310-312-1013
Practice Address - Fax:310-312-1014
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG323782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG32378Medicare ID - Type UnspecifiedLICENSE