Provider Demographics
NPI:1427059609
Name:PODRUMAR, ALIDA I (MD)
Entity type:Individual
Prefix:
First Name:ALIDA
Middle Name:I
Last Name:PODRUMAR
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 1:12502 WILLOWBROOK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6491
Mailing Address - Country:US
Mailing Address - Phone:240-964-8343
Mailing Address - Fax:240-964-8688
Practice Address - Street 1:12502 WILLOWBROOK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6491
Practice Address - Country:US
Practice Address - Phone:240-964-8343
Practice Address - Fax:240-964-8688
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063462207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCK307-0011OtherGHMSI BLUE CHOICE
WV3810008582Medicaid
MD409570700Medicaid
MD567B 646944-02OtherCAREFIRST BC BS
MD409570700Medicaid