Provider Demographics
NPI:1962852491
Name:VAJTA, NATALIE INDUCK (MD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:INDUCK
Last Name:VAJTA
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:PO BOX 744787
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4787
Mailing Address - Country:US
Mailing Address - Phone:301-754-3060
Mailing Address - Fax:301-681-0789
Practice Address - Street 1:3839 1/2 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1001
Practice Address - Country:US
Practice Address - Phone:202-582-6800
Practice Address - Fax:202-584-1665
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39739208000000X
MDD0094900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCF9996084OtherMEDICARE PIN
MD266330900Medicaid
SC397396Medicaid
DC065977233Medicaid