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General NPI Number Information
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NPI Number | 1205066180
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Entity Type | Individual
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Provider Name | DENNIS EVGENYEVICH RADOSHKEVICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2009
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 206 CORNELIA ST SUITE 202
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City | PLATTSBURGH
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State | NY
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Zip | 12901-2779
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Country | US
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Telephone | 518-562-7777
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Fax | 518-562-7707
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Provider Business Mailing Address
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Address Line | 420 OVINGTON AVE APT 5A
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City | BROOKLYN
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State | NY
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Zip | 11209-1532
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Country | US
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Telephone | 718-921-6270
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 253332
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License Number State | NY
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