Healthcare Provider Details

I. General information

NPI: 1023038874
Provider Name (Legal Business Name): VLADIMIR VLADIMIR IAKOMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 LANCASTER AVE
CHRISTIANA PA
17509-9504
US

IV. Provider business mailing address

23 LANCASTER AVE
CHRISTIANA PA
17509-9504
US

V. Phone/Fax

Practice location:
  • Phone: 717-786-0612
  • Fax: 717-806-0100
Mailing address:
  • Phone: 717-786-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD419298
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: