Provider Demographics
NPI:1750109583
Name:PODRAZA, CLAIRE ADELE (PAC)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ADELE
Last Name:PODRAZA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 MACARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-4523
Mailing Address - Country:US
Mailing Address - Phone:610-262-1519
Mailing Address - Fax:
Practice Address - Street 1:2363 MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-4523
Practice Address - Country:US
Practice Address - Phone:610-262-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA066048363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant