Basic Information
| Provider Information | |||||||||
| NPI: | 1790892172 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORADOWSKI | ||||||||
| FirstName: | YOLANDA | ||||||||
| MiddleName: | DANUTA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 ALICE PECK DAY DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037662694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034483121 | ||||||||
| FaxNumber: | 6034487462 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 ALICE PECK DAY DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037662901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034483122 | ||||||||
| FaxNumber: | 6034487491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 04/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 14565 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30208983 | 05 | NH | MEDICAID | 1790892172 | 01 | NH | ANTHEM | OTHER | 1790892172 | 01 | VT | BCBS OF VT | OTHER | 020222791 | 01 | CIGNA | OTHER | AA155775 | 01 | HARVARD PILGRIM | OTHER | 020222791 | 01 | NH | CBA | OTHER | 1016763 | 05 | VT | MEDICAID | 200071211 | 01 | MVP | OTHER |