Individual
VLADA W MARDOVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1164 E HOME RD, SPRINGFIELD, OH 45503-2726
(937) 342-9260
(937) 342-9262
Mailing address
1164 E HOME RD, SUITE J, SPRINGFIELD, OH 45503-2726
(937) 342-9260
(937) 342-9262
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35069608
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007490231
AETNA
OH
05
—
0267358
—
OH
01
—
1900693
UNITED HEALTHCARE
—
01
—
340018970
RR MEDICARE
—
01
—
MA4047453
OTHER MEDICARE LOCATION
OH
Enumeration date
11/22/2006
Last updated
01/05/2011
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