Provider Demographics
NPI:1053395020
Name:PODOLSKY, SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:PODOLSKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-4054
Mailing Address - Fax:617-724-8067
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:3RD FLOOR S50 300
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-724-4054
Practice Address - Fax:617-724-8067
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2012-07-31
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Provider Licenses
StateLicense IDTaxonomies
MA160896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA408563OtherTUFTS HEALTH PLAN
MA3208117Medicaid
MAJ22271OtherBCBS MA
MA3208117Medicaid
MAJ22271OtherBCBS MA