Provider Demographics
NPI:1376626697
Name:NEDELCOVYCH, PIERRE SAVA (MD)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:SAVA
Last Name:NEDELCOVYCH
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 1:595 BOWSPRIT LN
Mailing Address - Street 2:
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-3513
Mailing Address - Country:US
Mailing Address - Phone:703-864-1092
Mailing Address - Fax:
Practice Address - Street 1:595 BOWSPRIT LN
Practice Address - Street 2:
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-3513
Practice Address - Country:US
Practice Address - Phone:703-864-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98713207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002477200Medicaid
FL002477200Medicaid
FLD0993ZMedicare PIN