Provider Demographics
NPI:1144205030
Name:KOLEV, SERGE N (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGE
Middle Name:N
Last Name:KOLEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SERGE
Other - Middle Name:N
Other - Last Name:KOLEV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1300 BENT CREEK BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1871
Mailing Address - Country:US
Mailing Address - Phone:717-458-8401
Mailing Address - Fax:717-458-8403
Practice Address - Street 1:1300 BENT CREEK BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1871
Practice Address - Country:US
Practice Address - Phone:717-458-8401
Practice Address - Fax:717-458-8403
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064859Y207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016961160002Medicaid
354924OtherHIGHMARK BLUE SHIELD
50000718OtherCAPITAL BLUE CROSS
G71373Medicare UPIN
PA010557Medicare PIN