Provider Demographics
NPI:1083875637
Name:DEMENTOVYCH, NATALIYA (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIYA
Middle Name:
Last Name:DEMENTOVYCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 HIGHLAND AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3714
Mailing Address - Country:US
Mailing Address - Phone:215-481-4811
Mailing Address - Fax:
Practice Address - Street 1:1245 HIGHLAND AVE STE 302
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3724
Practice Address - Country:US
Practice Address - Phone:215-481-4811
Practice Address - Fax:215-576-1787
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443831207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA242745Medicare PIN