1275571945 NPI number — DR. OLEG VOLCHONOK M.D.

Table of content: DR. OLEG VOLCHONOK M.D. (NPI 1275571945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275571945 NPI number — DR. OLEG VOLCHONOK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOLCHONOK
Provider First Name:
OLEG
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1275571945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1618 ASTOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08003-3548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-969-8446
Provider Business Mailing Address Fax Number:
215-969-4451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11400 BUSTLETON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19116-2815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-969-8446
Provider Business Practice Location Address Fax Number:
215-969-4451
Provider Enumeration Date:
06/03/2006

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: 207RG0100X , with the licence number:  MD 055985-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: MA 064781 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0443857000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0443857000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2213876003 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5764478 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015313860007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7185201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1761748 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com