Provider Demographics
NPI:1255868238
Name:PATEDAKIS LITVINOV, BOGDAN IOANNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BOGDAN
Middle Name:IOANNIS
Last Name:PATEDAKIS LITVINOV
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 1:15 YORK STREET
Mailing Address - Street 2:LCI 910
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8018
Mailing Address - Country:US
Mailing Address - Phone:203-785-4085
Mailing Address - Fax:
Practice Address - Street 1:15 YORK STREET
Practice Address - Street 2:LCI 910
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8018
Practice Address - Country:US
Practice Address - Phone:203-785-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT681382084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology