Physician Compare National (NPI:1053527234)

HEALTHCARE PROVIDER: ELENA MEDVEDOVSKY MSW

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

Individual Professional Information
NPI	1053527234
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577741958
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110707000527
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MEDVEDOVSKI-KHAN
	Individual professional last name
Provider First Name	ELENA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	17 HENSHAW ST
	Group Practice or individual's line 1 address
City	BRIGHTON
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	021352905
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6176696059
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y