MEDICARE: DR. RICHARD PODOLNY 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
1	207Q00000X	Family Medicine Physician	13721	HI

General Provider Information

NPI Number	:	1659592764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD PODOLNY M.D.

Provider Business Mailing Address
First Line	:	1188 BISHOP ST
Second Line	:	STE 3306
City	:	HONOLULU
State	:	HI
Zip	:	96813-3301
Country	:	US
Telephone Number	:	808-386-2873
Fax Number	:

Provider Business Practice Location Address
First Line	:	1188 BISHOP ST
Second Line	:	STE 3306
City	:	HONOLULU
State	:	HI
Zip	:	96813-3301
Country	:	US
Telephone Number	:	808-386-2873
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	04/04/2011

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