Provider Demographics
NPI:1306831961
Name:DAROVSKY, BORIS M (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:M
Last Name:DAROVSKY
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 1:2232 WILBORN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1662
Mailing Address - Country:US
Mailing Address - Phone:434-517-8140
Mailing Address - Fax:434-575-1130
Practice Address - Street 1:2232 WILBORN AVE STE D
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1662
Practice Address - Country:US
Practice Address - Phone:434-517-8140
Practice Address - Fax:434-575-1130
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200700659207R00000X, 207RH0003X
NC2007-00659207R00000X, 207RH0003X
VA0101237543207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900712Medicaid
1306831961OtherNPID
2021887Medicare PIN
I28238Medicare UPIN