Provider Demographics
NPI:1871982124
Name:ODINETS, VLADIMIR (PA-C)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:ODINETS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3305
Mailing Address - Country:US
Mailing Address - Phone:574-169-2188
Mailing Address - Fax:617-691-5274
Practice Address - Street 1:399 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3305
Practice Address - Country:US
Practice Address - Phone:857-416-9218
Practice Address - Fax:617-691-5274
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMCS002361J363AM0700X
TXPAT363AM0700X
MAPA8660363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical