Healthcare Provider Details

I. General information

NPI: 1619976230
Provider Name (Legal Business Name): JAKE VRDOLJAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VATROSLAV VRDOLJAK MD

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8926 WOODYARD RD SUITE 301
CLINTON MD
20735
US

IV. Provider business mailing address

17310 WRIGHT ST STE 103
OMAHA NE
68130-2405
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-3670
  • Fax: 301-868-0129
Mailing address:
  • Phone: 833-228-6889
  • Fax: 877-853-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13076C
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number285721
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD31914
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number0101222180
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number036095623
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number16881
License Number StateND
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2020036306
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0053852
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: