Healthcare Provider Details

I. General information

NPI: 1851778005
Provider Name (Legal Business Name): VADIM KOROGODA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4534 FALLOWOOD TER
HIGH POINT NC
27265-9495
US

IV. Provider business mailing address

601 N ELM ST
HIGH POINT NC
27262-4331
US

V. Phone/Fax

Practice location:
  • Phone: 336-875-6530
  • Fax:
Mailing address:
  • Phone: 336-875-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6327
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number103691
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number576032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: