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NPI Code Detail

MEDICARE: VICTOR N OTVERTCHENKO M.D.

MEDICARE: VICTOR N OTVERTCHENKO M.D.
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
1207L00000XAnesthesiology Physician215447NY

Other Identifiers

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

General Provider Information

NPI Number : 1720086234
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTOR N OTVERTCHENKO M.D.
Provider Business Mailing Address
First Line : 19 BRADHURST AVE STE 3100N
Second Line :
City : HAWTHORNE
State : NY
Zip : 10532-2140
Country : US
Telephone Number : 914-909-9018
Fax Number : 914-909-9028
Provider Business Practice Location Address
First Line : 241 NORTH RD
Second Line :
City : POUGHKEEPSIE
State : NY
Zip : 12601-1154
Country : US
Telephone Number : 845-483-5989
Fax Number : 845-483-5912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 09/01/2021

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