MEDICARE: TODD D. VLADYKA DO

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	207Q00000X	Family Medicine Physician	OS009403L	PA

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

General Provider Information

NPI Number	:	1700887858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD D. VLADYKA DO

Provider Business Mailing Address
First Line	:	4190 CITY LINE AVE
Second Line	:	SUITE 777
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-1626
Country	:	US
Telephone Number	:	215-871-6910
Fax Number	:	215-871-6905

Provider Business Practice Location Address
First Line	:	4190 CITY LINE AVE
Second Line	:	SUITE 100
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-1626
Country	:	US
Telephone Number	:	215-871-6380
Fax Number	:	215-871-6381

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/16/2011

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Directions to “ TODD D. VLADYKA DO” Practice Location

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