Provider Demographics
NPI:1316946635
Name:PODGORSKI, EDWARD M (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:PODGORSKI
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:PO BOX 1710
Mailing Address - Street 2:SOUTH JERSEY RADIOLOGY ASSOCIATES, PA
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-7710
Mailing Address - Country:US
Mailing Address - Phone:856-770-0504
Mailing Address - Fax:856-770-0395
Practice Address - Street 1:100 CARNIE BLVD
Practice Address - Street 2:SUITE B-5
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4512
Practice Address - Country:US
Practice Address - Phone:856-751-0123
Practice Address - Fax:856-751-0535
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA049295002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0733221OtherAETNA
1090851OtherHORIZON NJ HEALTH
PO193699OtherHIGHMARK PA BLUE SHIELD
NJ1339206Medicaid
A3738029OtherOXFORD HEALTH
009151000OtherAMERIHEALTH
1244985OtherUNITED HEALTHCARE
300047118OtherRAILROAD MEDICARE
PO193699OtherPREMIER BLUE
0733221OtherAETNA
PO193699OtherPREMIER BLUE