Provider Demographics
NPI:1194831495
Name:DIMITROV, VESELIN (MD)
Entity Type:Individual
Prefix:
First Name:VESELIN
Middle Name:
Last Name:DIMITROV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-8768
Mailing Address - Country:US
Mailing Address - Phone:800-639-0579
Mailing Address - Fax:
Practice Address - Street 1:110 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-1611
Practice Address - Country:US
Practice Address - Phone:800-514-1494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076535207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2159686Medicaid
OH000000187190OtherBCBS
P00168177OtherRR MCR
OH0891408Medicare PIN
OH0891404Medicare PIN
OH0891409Medicare PIN
OH000000187190OtherBCBS