Basic Information
| Provider Information | |||||||||
| NPI: | 1316929375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PODOLSKY | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | KALMAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5323 HARRY HINES BOULEVARD | ||||||||
| Address2: | (B12.100) | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753909002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146482508 | ||||||||
| FaxNumber: | 2146488690 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 INWOOD ROAD, | ||||||||
| Address2: | 6TH FLOOR, SUITE 102 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146450595 | ||||||||
| FaxNumber: | 2146450581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 12/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 45936 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 42347 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | #8BQ932 | 01 | TX | BLUE CROSS/BLUE SHIELD OF TEXAS | OTHER | 0152579 | 05 | MA | MEDICAID | 045936 | 01 | MA | TUFTS HEALTH PLAN | OTHER | E05681 | 01 | MA | BCBS MA | OTHER |