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General NPI Number Information
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NPI Number | 1912362716
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Entity Type | Organization
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Legal Business Name | JANET VODVARKA
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Dates
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Enumeration Date | 12/21/2015
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 27 WALTHAM RD
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City | WAYLAND
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State | MA
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Zip | 01778-1312
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Country | US
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Telephone | 598-358-9688
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Fax |
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Provider Business Mailing Address
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Address Line | 27 WALTHAM ROAD
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City | WAYLAND
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State | MA
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Zip | 01778
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Country | US
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Telephone | 598-358-9688
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Fax |
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Authorized Official
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Title or Position | SOLE PRACTITIONER
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Name | DR. JANET VODVARKA
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Credential | PH.D.
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Telephone | 508-358-9688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 2613
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License Number State | MA
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