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General NPI Number Information
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NPI Number | 1790951390
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Entity Type | Organization
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Legal Business Name | OLEG VOLCHONOK, MD, PC
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Dates
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Enumeration Date | 05/02/2008
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Last Update Date | 04/05/2010
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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 | 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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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OLEG VOLCHONOK
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Credential | M.D.
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Telephone | 215-969-8446
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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 | MD055985L
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License Number State | PA
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