Provider Demographics
NPI:1164525416
Name:CHOUMAROV, KYRIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KYRIL
Middle Name:
Last Name:CHOUMAROV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:251 SALINA MEADOWS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2096
Practice Address - Street 1:750 EAST ADAMS ST
Practice Address - Street 2:STE 4835
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-1800
Practice Address - Fax:315-464-6238
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21593208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006121Medicaid
WVP00424422OtherRAILROAD MEDICARE
WV3810006121Medicaid
WVP00424422OtherRAILROAD MEDICARE