1104882646 NPI number — VIOLETTA BERDICHEVSKAYA M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104882646 NPI number — VIOLETTA BERDICHEVSKAYA M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BERDICHEVSKAYA

Provider First Name:

VIOLETTA

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1104882646

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/11/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1 W ELM ST

Provider Second Line Business Mailing Address:

SUITE 100

Provider Business Mailing Address City Name:

CONSHOHOCKEN

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19428-2007

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-567-6967

Provider Business Mailing Address Fax Number:

610-567-6170

Provider First Line Business Practice Location Address:

2701 HOLME AVE

Provider Second Line Business Practice Location Address:

SUITE 201

Provider Business Practice Location Address City Name:

PHILADELPHIA

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

19152-2029

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

215-350-7417

Provider Business Practice Location Address Fax Number:

215-335-6303

Provider Enumeration Date:

04/25/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  MD418392 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1194654 . This is a "AETNA USH HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1442044 . This is a "PA BLUE SHIELD #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2125868000 . This is a "IBC #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 9254256 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: HIGHMARK BLUE SHIELD . This is a "1442044" identifier . This identifiers is of the category "OTHER".
• Identifier: 9973 . This is a "BRAVO ELDERHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 37809MD418392 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 30043419 . This is a "KMHP WOODWARD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0019378550002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 30029002 . This is a "KMHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 7546410 . This is a "AETNA USH PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".