Provider Demographics
NPI:1699729798
Name:VORONTSOVA, NATALYA V (MD)
Entity type:Individual
Prefix:
First Name:NATALYA
Middle Name:V
Last Name:VORONTSOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALYA
Other - Middle Name:VLADMIROVNA
Other - Last Name:OLDENDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CENTRE STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131
Mailing Address - Country:US
Mailing Address - Phone:617-363-8616
Mailing Address - Fax:617-363-8929
Practice Address - Street 1:1200 CENTRE STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02131
Practice Address - Country:US
Practice Address - Phone:617-363-8616
Practice Address - Fax:617-363-8929
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082577207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOL7314111Medicare ID - Type UnspecifiedMDC NUMBER
OHH88603Medicare UPIN
H88603Medicare UPIN