Provider Demographics
NPI:1437134335
Name:SOLOVIEVA, ANASTASIA SERGEYEVN (MD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:SERGEYEVN
Last Name:SOLOVIEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 NW US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-6100
Mailing Address - Country:US
Mailing Address - Phone:352-564-0697
Mailing Address - Fax:
Practice Address - Street 1:262 LEROY GEORGE DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7430
Practice Address - Country:US
Practice Address - Phone:828-456-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD26456207V00000X
MO2004027805207V00000X
NC2022-01251207V00000X
FLME118153207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209158708Medicaid
MO929771740Medicare PIN
MO209158708Medicaid
MO261811Medicare Oscar/Certification