MEDICARE: KATHERINE PAIGE PODLASKI

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	390200000X	Student in an Organized Health Care Education/Training Program		PA

General Provider Information

NPI Number	:	1952025355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE PAIGE PODLASKI

Provider Business Mailing Address
First Line	:	509 HEDGE ROW CT
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-7715
Country	:	US
Telephone Number	:	724-996-7592
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 HEDGE ROW CT
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-7715
Country	:	US
Telephone Number	:	724-996-7592
Fax Number	:

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

Provider Enumeration Date	:	09/29/2022
Last Update Date	:	09/29/2022

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