Provider Demographics
NPI:1386644433
Name:PROYTCHEVA, MARIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:PROYTCHEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:A
Other - Last Name:KLENOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 29681
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9681
Mailing Address - Country:US
Mailing Address - Phone:520-874-4135
Mailing Address - Fax:520-874-3480
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85714
Practice Address - Country:US
Practice Address - Phone:520-874-4135
Practice Address - Fax:520-874-3480
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45432207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ666388Medicaid
AZZ150313Medicare PIN