Provider Demographics
NPI:1275571945
Name:VOLCHONOK, OLEG (MD)
Entity Type:Individual
Prefix:DR
First Name:OLEG
Middle Name:
Last Name:VOLCHONOK
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 1:1618 ASTOR DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3548
Mailing Address - Country:US
Mailing Address - Phone:215-969-8446
Mailing Address - Fax:215-969-4451
Practice Address - Street 1:11400 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2815
Practice Address - Country:US
Practice Address - Phone:215-969-8446
Practice Address - Fax:215-969-4451
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 055985-L207RG0100X
NJMA 064781207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0443857000OtherINDEPENDENCE BLUE CROSS
NJ0443857000OtherAMERIHEALTH
PA2213876003OtherCIGNA
PA5764478OtherAETNA
PA0015313860007Medicaid
NJ7185201Medicaid
PA1761748OtherUNITED HEALTHCARE
PA1761748OtherUNITED HEALTHCARE
NJ7185201Medicaid
PA0443857000OtherINDEPENDENCE BLUE CROSS