Provider Demographics
NPI:1104132554
Name:PODDAR, PIYUSH (MD)
Entity type:Individual
Prefix:DR
First Name:PIYUSH
Middle Name:
Last Name:PODDAR
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 1:9500 EUCLID AVENUE
Mailing Address - Street 2:A50
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195
Mailing Address - Country:US
Mailing Address - Phone:860-985-7489
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVENUE
Practice Address - Street 2:A50
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-444-5627
Practice Address - Fax:216-445-7569
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN15225207R00000X
OH57.022470207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology