1467419820 NPI number — BORIS G NAYDICH M.D.

Table of content: BORIS G NAYDICH M.D. (NPI 1467419820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467419820 NPI number — BORIS G NAYDICH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAYDICH
Provider First Name:
BORIS
Provider Middle Name:
G
Provider Name Prefix Text:
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:
1467419820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 418837
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-8837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-846-5527
Provider Business Mailing Address Fax Number:
607-324-2369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11340 PEMBROOKE SQ
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20603-4808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-705-5802
Provider Business Practice Location Address Fax Number:
301-843-1704
Provider Enumeration Date:
04/28/2006

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: 2085R0001X , with the licence number:  D0050619 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00001407704 22 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 9048249 . This is a "PHCS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 683702600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18985 . This is a "JOHNS HOPKINS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 220845 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2696604 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4444286011 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 034466600 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5729732 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 29020008 . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 497788 . This is a "NATIONAL CAPITOL PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 51759 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 60332704 . This is a "CARE FIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1085669 . This is a "FIRST HEALTH/CCN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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