Provider Demographics
NPI:1891731667
Name:PODOLTSEV, NIKOLAI ALEXANDROVICH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAI
Middle Name:ALEXANDROVICH
Last Name:PODOLTSEV
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Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:PO BOX 208032
Mailing Address - Street 2:YALE UNIVERSITY SCHOOL OF MEDICINE, HEMATOLOGY DIVISION
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8032
Mailing Address - Country:US
Mailing Address - Phone:203-200-4363
Mailing Address - Fax:203-785-3788
Practice Address - Street 1:333 CEDAR ST
Practice Address - Street 2:YALE UNIVERSITY SCHOOL OF MEDICINE, HEMATOLOGY DIVISION
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:203-200-4363
Practice Address - Fax:203-785-3788
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-01-11
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Provider Licenses
StateLicense IDTaxonomies
CT038990207R00000X, 207RX0202X, 207RH0003X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001389908Medicaid
CTH46684Medicare UPIN
CT001389908Medicaid
CT110008386Medicare ID - Type Unspecified