Provider Demographics
NPI:1548467616
Name:VADIM SCHALDENKO MDPC
Entity type:Organization
Organization Name:VADIM SCHALDENKO MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHALDENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-957-4850
Mailing Address - Street 1:505 NASHUA RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-1929
Mailing Address - Country:US
Mailing Address - Phone:978-957-4850
Mailing Address - Fax:
Practice Address - Street 1:505 NASHUA RD
Practice Address - Street 2:SUITE 12
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-1929
Practice Address - Country:US
Practice Address - Phone:978-957-4850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-30
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7895OtherHARVARD PILGRIM PROVIDER
MAB26223OtherBLUE CROSS PROVIDER NUMER
MA040961OtherTUFTS PROVIDER NUMBER
A34706Medicare UPIN
MAM13022Medicare ID - Type Unspecified