Healthcare Provider Details

I. General information

NPI: 1477862852
Provider Name (Legal Business Name): NICOLE LEEANN PODJED P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 MAIN ST STE 201
PHOENIXVILLE PA
19460-4459
US

IV. Provider business mailing address

826 MAIN ST STE 201
PHOENIXVILLE PA
19460-4459
US

V. Phone/Fax

Practice location:
  • Phone: 610-415-1100
  • Fax: 610-415-1101
Mailing address:
  • Phone: 610-415-1100
  • Fax: 610-415-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054511
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: