MEDICARE: DR. AIDA AVDIC MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	042.0012317	VT
2	207R00000X	Internal Medicine Physician	FA1452969	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154484772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AIDA AVDIC MD

Provider Business Mailing Address
First Line	:	3400 SPRUCE ST
Second Line	:	PENN TOWER SUIT 2009
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4206
Country	:	US
Telephone Number	:	215-662-3797
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 BELMONT AVE STE 1
Second Line	:
City	:	BRATTLEBORO
State	:	VT
Zip	:	05301-3498
Country	:	US
Telephone Number	:	802-257-0341
Fax Number	:	802-257-8834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	01/26/2022

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