Provider Demographics
NPI:1124564703
Name:FALL PREVENTION AND STROKE REHAB PHYSICIAN, LLC
Entity Type:Organization
Organization Name:FALL PREVENTION AND STROKE REHAB PHYSICIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATANELOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-543-6773
Mailing Address - Street 1:2701 JEREMY CT APT E
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 JEREMY CT APT E
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3062
Practice Address - Country:US
Practice Address - Phone:443-543-6773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty