1649276668 NPI number — EVGENIY A SHCHELCHKOV MD

Table of content: EVGENIY A SHCHELCHKOV MD (NPI 1649276668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649276668 NPI number — EVGENIY A SHCHELCHKOV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHCHELCHKOV
Provider First Name:
EVGENIY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649276668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 OVERLOOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANONSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15317-2657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-941-6057
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 OVERLOOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANONSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-2657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-941-6057
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  0101235474 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: MD421060 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 345616 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7730501 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010044791 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10028259 . This is a "OPTIMA/SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1649276668 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5927775 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 107411200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".