Active NPI
Richard Michael Podolin, PH D
- Psychologist
- Annapolis, MD
National Provider Identifier
1033265749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 02355
- Practice address
- 2002 Medical Pkwy
Suite 430
Annapolis, MD 21401-3046 - Phone
- (410) 757-1005
- Fax
- (410) 757-3788
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 02355 | MD | Primary |
Addresses
Primary practice location
2002 Medical Pkwy
Suite 430
Annapolis, MD 21401-3046
Mailing address
1290 Bay Dale Dr
PMB 150
Arnold, MD 21012-2325
Phone (410) 757-1005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2021 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02355 | MD | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1033265749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1290 BAY DALE DR",
"address_2": "PMB 150",
"city": "ARNOLD",
"state": "MD",
"postal_code": "210122325",
"telephone_number": "410-757-1005",
"fax_number": "410-757-3788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2002 MEDICAL PKWY",
"address_2": "SUITE 430",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214013046",
"telephone_number": "410-757-1005",
"fax_number": "410-757-3788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PODOLIN",
"first_name": "RICHARD",
"middle_name": "MICHAEL",
"credential": "PH D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MD",
"license": "02355",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Annapolis, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.