MEDICARE: DR. EDWARD MARION PODGORSKI III III MD

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	207R00000X	Internal Medicine Physician	268113	MA
2	208VP0014X	Interventional Pain Medicine Physician	63778	AZ
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	63778	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760832828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD MARION PODGORSKI III III MD

Provider Business Mailing Address
First Line	:	2727 W MLK BLVD STE 520
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6000
Country	:	US
Telephone Number	:	813-538-7600
Fax Number	:	813-538-7600

Provider Business Practice Location Address
First Line	:	2727 W MLK BLVD STE 520
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6000
Country	:	US
Telephone Number	:	215-779-9999
Fax Number	:	564-524-6512

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

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	02/14/2023

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