Provider Demographics
NPI:1255394102
Name:POGODA, WILLIAM J (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:POGODA
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 1:9 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD761711900Medicaid
MD761711900Medicaid
MD6556Medicare PIN
MD0780440001Medicare NSC