Provider Demographics
NPI:1104882646
Name:BERDICHEVSKAYA, VIOLETTA (MD)
Entity type:Individual
Prefix:
First Name:VIOLETTA
Middle Name:
Last Name:BERDICHEVSKAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6967
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:2701 HOLME AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:215-350-7417
Practice Address - Fax:215-335-6303
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1194654OtherAETNA USH HMO
PA1442044OtherPA BLUE SHIELD #
PA2125868000OtherIBC #
PA9254256OtherCIGNA
HIGHMARK BLUE SHIELDOther1442044
PA9973OtherBRAVO ELDERHEALTH
PA37809MD418392OtherHEALTHPARTNERS
PA30043419OtherKMHP WOODWARD
PA0019378550002Medicaid
PA30029002OtherKMHP
PA7546410OtherAETNA USH PPO
PAH56251Medicare UPIN
PA1194654OtherAETNA USH HMO
PAP00352091Medicare PIN