1821093006 NPI number — ANDREJ V HNATOV MD

Table of content: ANDREJ V HNATOV MD (NPI 1821093006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821093006 NPI number — ANDREJ V HNATOV MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HNATOV
Provider First Name:
ANDREJ
Provider Middle Name:
V
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:
1821093006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2234 COLONIAL BLVD
Provider Second Line Business Mailing Address:
MANAGED CARE DEPARTMENT
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-1412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-931-7342
Provider Business Mailing Address Fax Number:
239-931-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 WH SMITH BLVD
Provider Second Line Business Practice Location Address:
CAROLINA RADIATION MEDICINE, PA
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-329-0025
Provider Business Practice Location Address Fax Number:
252-329-0325
Provider Enumeration Date:
06/15/2005

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: 2085R0001X , with the licence number:  2003-00355 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13361 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: C6602 . This is a "MED COST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7713451 . This is a "AETNA PROVIDER ID #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8913361 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00612670 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8033403 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P01619313 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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