Basic Information
| Provider Information | |||||||||
| NPI: | 1417064635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENDIOUKOVA | ||||||||
| FirstName: | TATIANA | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 CHESTNUT ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011991001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137945700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 380 PLAINFIELD ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137944458 | ||||||||
| FaxNumber: | 4137945131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 09/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 234797 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1417064635 | 01 | TUFTS (BAYCARE HEALTH PARTNERS) | OTHER | 1417064635 | 01 | FALLON HEALTH CARE(BAYCARE HEALTH PARTNERS) | OTHER | 954013 | 01 | MA | NETWORK HEALTH | OTHER | MB0710550A | 01 | MA | CONTROLLED SUBSTANCE REGISTRATION | OTHER | 1310097 | 05 | MA | MEDICAID | 1417064635 | 01 | MA | BC/BS | OTHER | 1417064635 | 01 | MA | NHP | OTHER | 1417064635 | 01 | NPI | OTHER | 234797 | 01 | CT | CONNECTICARE | OTHER | 43781 | 01 | MA | HNE | OTHER | AA116484 | 01 | HARVARD PILGRIM | OTHER | 1417064635 | 01 | MA | AETNA | OTHER | 1417064635 | 01 | UNITED HEALTHCARE | OTHER | BB8205280 | 01 | DEA | OTHER | 1417064635 | 01 | MA | BMC HEALTH NET PLAN | OTHER |