Provider Demographics
NPI:1235143223
Name:MARKOV, DIMITRI D (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMITRI
Middle Name:D
Last Name:MARKOV
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 1:211 S 9TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6810
Mailing Address - Country:US
Mailing Address - Phone:215-955-6175
Mailing Address - Fax:215-955-9783
Practice Address - Street 1:211 S 9TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6810
Practice Address - Country:US
Practice Address - Phone:215-955-6175
Practice Address - Fax:215-955-9783
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4202262084P0800X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1490030OtherBLUE SHIELD OF PA
PA2179723000OtherKEYSTONE HEALTH PLAN EAST
PA7681568OtherAETNA
PA0019717210002Medicaid
PA1490030OtherPERSONAL CHOICE
PA1490030OtherPERSONAL CHOICE
PA2179723000OtherKEYSTONE HEALTH PLAN EAST