Provider Demographics
NPI:1376680660
Name:MRAVKOV, BORISLAV MARGARITOV (MD)
Entity Type:Individual
Prefix:
First Name:BORISLAV
Middle Name:MARGARITOV
Last Name:MRAVKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:910-721-4220
Mailing Address - Fax:910-721-4229
Practice Address - Street 1:204 SMITH AVE
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4458
Practice Address - Country:US
Practice Address - Phone:910-721-4220
Practice Address - Fax:910-721-4229
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN729652084N0400X
NC2008-010022084N0400X
KYC22242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology