Individual
NINO DGEBUADZE
Active
Individual
NINO DGEBUADZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., PH.D.
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
2007012244
MO
208100000X
Physical Medicine & Rehabilitation Physician
Primary
D0073349
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
333505400
—
MD
01
—
97628601
BCBS LOCAL CAREFIRST KG85
MD
01
—
P01024230
RR MEDICARE MD
MD
01
—
W2660030
BCBS REGIONAL W266
MD
Enumeration date
06/27/2007
Last updated
11/20/2018
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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