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NPI Code Detail

MEDICARE: MARK M. PODBEREZIN M.D.

MEDICARE: MARK M. PODBEREZIN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianR2444TX
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician125051820IL
3207ZH0000XHematology (Pathology) Physician276739MA
4207ZP0101XAnatomic Pathology Physician313226NY
5207ZP0102XAnatomic Pathology & Clinical Pathology Physician276739MA

General Provider Information

NPI Number : 1174782676
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK M. PODBEREZIN M.D.
Provider Business Mailing Address
First Line : 1355 RIVER BEND DR
Second Line :
City : DALLAS
State : TX
Zip : 75247-4915
Country : US
Telephone Number : 214-237-1818
Fax Number :
Provider Business Practice Location Address
First Line : 1355 RIVER BEND DR
Second Line :
City : DALLAS
State : TX
Zip : 75247-4915
Country : US
Telephone Number : 214-237-1818
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2008
Last Update Date : 01/05/2026

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