Provider Demographics
NPI:1497918593
Name:NETCHVOLODOFF, CATHERINE VADIME (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:VADIME
Last Name:NETCHVOLODOFF
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 1:9 BERWYN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2201
Mailing Address - Country:US
Mailing Address - Phone:501-221-7087
Mailing Address - Fax:662-284-9920
Practice Address - Street 1:3050 CORDER DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6210
Practice Address - Country:US
Practice Address - Phone:662-284-9995
Practice Address - Fax:662-284-9920
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4121207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR4121OtherARKANSAS STATE MEDICAL LICENSE
MS19787OtherMS STATE MEDICAL LICENSE
AR118448001Medicaid
ARR4121OtherARKANSAS STATE MEDICAL LICENSE
ARE66993Medicare UPIN