1518088061 NPI number — VESELIN S STOYANOV MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518088061 NPI number — VESELIN S STOYANOV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOYANOV
Provider First Name:
VESELIN
Provider Middle Name:
S
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:
1518088061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4627 RUE BORDEAUX
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUTZ
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33558-5365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-749-6006
Provider Business Mailing Address Fax Number:
727-372-1009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 LITTLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34655-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-372-1005
Provider Business Practice Location Address Fax Number:
727-801-7081
Provider Enumeration Date:
04/03/2007

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: 207Q00000X , with the licence number:  ME98240 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 95142 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: K5888 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 279669400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01036787 . This is a "RAILROAD MEDICARE ATTACHED TO GRP# DR6927" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: K2539 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 279669400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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