Provider Demographics
NPI:1396825022
Name:PROKHOV, VASSIL KOSTA (MD)
Entity Type:Individual
Prefix:
First Name:VASSIL
Middle Name:KOSTA
Last Name:PROKHOV
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 1:1050 BOWER HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243
Mailing Address - Country:US
Mailing Address - Phone:412-572-6190
Mailing Address - Fax:412-572-6946
Practice Address - Street 1:1050 BOWER HILL ROAD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243
Practice Address - Country:US
Practice Address - Phone:412-572-6190
Practice Address - Fax:412-572-6946
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA025849E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008614200003Medicaid
PA0008614200003Medicaid
PR181220Medicare ID - Type Unspecified