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General NPI Number Information
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NPI Number | 1275571945
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Entity Type | Individual
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Provider Name | OLEG VOLCHONOK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 11400 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19116-2815
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Country | US
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Telephone | 215-969-8446
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Fax | 215-969-4451
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Provider Business Mailing Address
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Address Line | 1618 ASTOR DR
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City | CHERRY HILL
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State | NJ
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Zip | 08003-3548
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Country | US
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Telephone | 215-969-8446
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Fax | 215-969-4451
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD 055985-L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MA 064781
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License Number State | NJ
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