Provider Demographics
NPI:1952348310
Name:PODWALL, BARBARA (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:PODWALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:LOEWENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:900 NORTHERN BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5302
Mailing Address - Country:US
Mailing Address - Phone:516-482-6700
Mailing Address - Fax:
Practice Address - Street 1:900 NORTHERN BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5302
Practice Address - Country:US
Practice Address - Phone:516-482-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227494-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY774S1YQPX1Medicare PIN
I37993Medicare UPIN