Healthcare Provider Details

I. General information

NPI: 1437197001
Provider Name (Legal Business Name): ANTHONY PODRAZA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 UNION ST SUITE 9
BANGOR ME
04401-3050
US

IV. Provider business mailing address

43 WHITING HILL RD SUITE 300
BREWER ME
04412-1005
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-4037
  • Fax: 207-973-8276
Mailing address:
  • Phone: 207-973-5035
  • Fax: 207-973-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS637
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: