Provider Demographics
NPI:1447237854
Name:TZVETAN TZVETANOV, INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:TZVETAN TZVETANOV, INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBETSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-688-1042
Mailing Address - Street 1:565 TURNPIKE STREET
Mailing Address - Street 2:SUITE #75
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5936
Mailing Address - Country:US
Mailing Address - Phone:978-722-1967
Mailing Address - Fax:
Practice Address - Street 1:565 TURNPIKE STREET
Practice Address - Street 2:SUITE #5
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5936
Practice Address - Country:US
Practice Address - Phone:978-722-1967
Practice Address - Fax:978-683-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9731695Medicaid
MA9731695Medicaid