Provider Demographics
NPI:1285718296
Name:VODENITCHAROVA, NEDA K (MD)
Entity type:Individual
Prefix:
First Name:NEDA
Middle Name:K
Last Name:VODENITCHAROVA
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 1:500 CENTRAL PARK AVE
Mailing Address - Street 2:#333
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1041
Mailing Address - Country:US
Mailing Address - Phone:914-725-7174
Mailing Address - Fax:
Practice Address - Street 1:1740 EASTCHESTER ROAD
Practice Address - Street 2:CALVARY HOSPITAL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-518-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY299AR1Medicare ID - Type Unspecified
130168Medicare UPIN