Physician Compare National (NPI:1023210317)

HEALTHCARE PROVIDER: GRIGORIY TSOTNEEVICH RODONAIA M.D. PA

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1023210317
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6103901913
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080304000446
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RODONAIA
	Individual professional last name
Provider First Name	GRIGORIY
	Individual professional first name
Provider Middle Name	T
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2955 HARRISON ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	BEAUMONT
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	777021156
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y