Provider Demographics
NPI:1417064635
Name:BENDIOUKOVA, TATIANA V (MD)
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:V
Last Name:BENDIOUKOVA
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 1:280 CHESTNUT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:380 PLAINFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1524
Practice Address - Country:US
Practice Address - Phone:413-794-4458
Practice Address - Fax:413-794-5131
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417064635OtherTUFTS (BAYCARE HEALTH PARTNERS)
1417064635OtherFALLON HEALTH CARE(BAYCARE HEALTH PARTNERS)
MA954013OtherNETWORK HEALTH
MAMB0710550AOtherCONTROLLED SUBSTANCE REGISTRATION
MA1310097Medicaid
MA1417064635OtherBC/BS
MA1417064635OtherNHP
1417064635OtherNPI
CT234797OtherCONNECTICARE
MA43781OtherHNE
AA116484OtherHARVARD PILGRIM
MA1417064635OtherAETNA
1417064635OtherUNITED HEALTHCARE
MA1417064635OtherBMC HEALTH NET PLAN
MA1417064635OtherBMC HEALTH NET PLAN
MA1417064635OtherBMC HEALTH NET PLAN
MA1417064635OtherAETNA