Healthcare Provider Details

I. General information

NPI: 1497918593
Provider Name (Legal Business Name): CATHERINE VADIME NETCHVOLODOFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 CORDER DR
CORINTH MS
38834-6210
US

IV. Provider business mailing address

9 BERWYN DR
LITTLE ROCK AR
72227-2201
US

V. Phone/Fax

Practice location:
  • Phone: 662-284-9995
  • Fax: 662-284-9920
Mailing address:
  • Phone: 501-221-7087
  • Fax: 662-284-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberR-4121
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: