Provider Demographics
NPI:1396815023
Name:VERED, ELDAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ELDAD
Middle Name:
Last Name:VERED
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 1:2376 N 400 E
Mailing Address - Street 2:204
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3413
Mailing Address - Country:US
Mailing Address - Phone:435-882-1433
Mailing Address - Fax:435-882-1431
Practice Address - Street 1:7785 N STATE ST STE 210
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-5475
Practice Address - Fax:315-376-5129
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6934299-8017207V00000X
NY175485207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1396815023Medicaid
CO85129836Medicaid
CO805216Medicare ID - Type Unspecified
E44166Medicare UPIN
UT000063611Medicare PIN