Provider Demographics
NPI:1629016019
Name:ZDRNJA, VLASTA F (MD)
Entity Type:Individual
Prefix:
First Name:VLASTA
Middle Name:F
Last Name:ZDRNJA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:195 MCGREGOR STREET
Mailing Address - Street 2:CATHOLIC MEDICAL CENTER
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102
Mailing Address - Country:US
Mailing Address - Phone:603-663-7852
Mailing Address - Fax:603-663-6579
Practice Address - Street 1:775 SOUTH MAIN STREET
Practice Address - Street 2:MEDICAL GROUP OF MANCHESTER
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-5103
Practice Address - Country:US
Practice Address - Phone:603-663-7300
Practice Address - Fax:603-663-7333
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2013-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2002021785207R00000X
NH12446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH01YP07684NH01OtherANTHEM BLUE CROSS
NH201628122OtherCIGNA
NHAA23297OtherHARVARD PILGRIM
NH30204721Medicaid
NH5551704OtherFIRST HEALTH
NHH71697Medicare UPIN
NHRE7943Medicare ID - Type Unspecified
P00273943Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NH01YP07684NH01OtherANTHEM BLUE CROSS