Provider Demographics
NPI:1023038874
Name:IAKOMI, VLADIMIR VLADIMIR (MD)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:VLADIMIR
Last Name:IAKOMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:PA
Mailing Address - Zip Code:17509-9504
Mailing Address - Country:US
Mailing Address - Phone:717-786-0612
Mailing Address - Fax:
Practice Address - Street 1:23 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:PA
Practice Address - Zip Code:17509-9504
Practice Address - Country:US
Practice Address - Phone:717-786-0612
Practice Address - Fax:717-806-0100
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419298208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081986MKAMedicare ID - Type Unspecified
PAI13249Medicare UPIN