Provider Demographics
NPI:1306961198
Name:PODOLSKY, CAROL P (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:P
Last Name:PODOLSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 EDMUNDS RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1331
Mailing Address - Country:US
Mailing Address - Phone:617-796-1420
Mailing Address - Fax:
Practice Address - Street 1:NEWTON HEALTH AND HUMAN SERVICES
Practice Address - Street 2:1294 CENTRE STREET
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-796-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49192208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics