Provider Demographics
NPI:1467419820
Name:NAYDICH, BORIS G (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:G
Last Name:NAYDICH
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:PO BOX 418837
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8837
Mailing Address - Country:US
Mailing Address - Phone:888-846-5527
Mailing Address - Fax:607-324-2369
Practice Address - Street 1:11340 PEMBROOKE SQ
Practice Address - Street 2:SUITE 201
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4808
Practice Address - Country:US
Practice Address - Phone:301-705-5802
Practice Address - Fax:301-843-1704
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00506192085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00001407704 22OtherUNITED HEALTHCARE
MD497788OtherNATIONAL CAPITOL PPO
DC034466600Medicaid
MD220845OtherMAMSI
MD5729732OtherAETNA PPO
MD2696604OtherAETNA HMO
DC29020008OtherCAREFIRST BC/BS
MD4444286011OtherCIGNA
MD9048249OtherPHCS
MD1085669OtherFIRST HEALTH/CCN
MD18985OtherJOHNS HOPKINS HEALTHCARE
MD51759OtherAMERIGROUP
MD60332704OtherCARE FIRST BC/BS
MD683702600Medicaid
MD920005900Medicare PIN
MD18985OtherJOHNS HOPKINS HEALTHCARE
MD00001407704 22OtherUNITED HEALTHCARE
MD005666S29Medicare PIN