1104834365 NPI number — JANET L VODRA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104834365 NPI number — JANET L VODRA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VODRA
Provider First Name:
JANET
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104834365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 GRANDVIEW AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06708-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-755-2344
Provider Business Mailing Address Fax Number:
203-573-8166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 GRANDVIEW AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06708-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-755-2344
Provider Business Practice Location Address Fax Number:
203-573-8166
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  033769 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0R0794 . This is a "HEALTHNET PROVIDER #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 127948 . This is a "WELLCARE PROVIDER #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010033769CT01 . This is a "ANTHEM PROVIDER #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0150262 . This is a "CIGNA PROVIDER #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0740431 . This is a "UNITED HEALTHCARE #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: NHP140 . This is a "OXFORD HEALTH PLAN #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010033769CT01 . This is a "ANTHEM FAMILY PLAN #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 033769 . This is a "CONNECTICARE PROVIDER #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 700583 . This is a "US HEALTHCARE #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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