MEDICARE: KATHERINE PODRAZA MD PHD

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
1	2084N0400X	Neurology Physician	A147830	CA
2	2084N0400X	Neurology Physician	73320	CT
3	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	73320	CT

General Provider Information

NPI Number	:	1457731986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE PODRAZA MD PHD

Provider Business Mailing Address
First Line	:	100 PERKINS FARM DR STE 303
Second Line	:
City	:	MYSTIC
State	:	CT
Zip	:	06355-4041
Country	:	US
Telephone Number	:	860-696-2925
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PERKINS FARM DR STE 303
Second Line	:
City	:	MYSTIC
State	:	CT
Zip	:	06355-4041
Country	:	US
Telephone Number	:	860-696-2925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2015
Last Update Date	:	07/08/2024

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