Provider Demographics
NPI:1336750421
Name:VDMD MEDICAL INC
Entity Type:Organization
Organization Name:VDMD MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VASILI
Authorized Official - Middle Name:
Authorized Official - Last Name:DZERHACHOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-253-9756
Mailing Address - Street 1:134 SAINT PATRICKS DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-5118
Mailing Address - Country:US
Mailing Address - Phone:904-253-9756
Mailing Address - Fax:
Practice Address - Street 1:1477 GROVE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1421
Practice Address - Country:US
Practice Address - Phone:415-563-0565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty