Provider Demographics
NPI:1639108756
Name:GAFTANYUK, OLGA (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:GAFTANYUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6 CRONIN BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-3951
Mailing Address - Country:US
Mailing Address - Phone:508-917-8026
Mailing Address - Fax:508-917-8026
Practice Address - Street 1:1132 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3878
Practice Address - Country:US
Practice Address - Phone:413-592-1980
Practice Address - Fax:413-439-0096
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2205612084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15-01529OtherEVERCARE
MA2074389Medicaid
MA466255OtherTUFTS
MAJ27847OtherBCBS
MAP00289511OtherRAIL ROAD MEDICARE
MA466255OtherTUFTS
MA15-01529OtherEVERCARE