Provider Demographics
NPI:1871686980
Name:KACHATUROFF, NORA MAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:MAYA
Last Name:KACHATUROFF
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 1:4411 BEE RIDGE RD PMB 309
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233
Mailing Address - Country:US
Mailing Address - Phone:941-926-6553
Mailing Address - Fax:941-296-8501
Practice Address - Street 1:1550 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293
Practice Address - Country:US
Practice Address - Phone:941-926-6553
Practice Address - Fax:941-296-8501
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143477207N00000X
PAMD465974207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0823500Medicare ID - Type Unspecified
MIB44473Medicare UPIN