Provider Demographics
NPI:1376596163
Name:VENDITTI, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:VENDITTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:195 WORCESTER STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:617-219-1510
Mailing Address - Fax:617-219-1512
Practice Address - Street 1:195 WORCESTER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5568
Practice Address - Country:US
Practice Address - Phone:617-219-1510
Practice Address - Fax:617-219-1512
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA73231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA073231OtherTUFTS
MA0015266OtherNEIGHBORHOOD HEALTH
MA3096262Medicaid
MAJ12782OtherBLUE CROSS
MAV293OtherHARVARD PILGRIM
MA3096262Medicaid
MAJ12782OtherBLUE CROSS