Provider Demographics
NPI:1477543064
Name:MIRTCHEV, KRASSIMIRE ENTCHEV (MD)
Entity Type:Individual
Prefix:
First Name:KRASSIMIRE
Middle Name:ENTCHEV
Last Name:MIRTCHEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DAYTON LANE
Mailing Address - Street 2:THE WESTCHESTER MEDICAL PRATICE PC
Mailing Address - City:PEEKKSILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566
Mailing Address - Country:US
Mailing Address - Phone:914-739-0087
Mailing Address - Fax:914-737-1714
Practice Address - Street 1:1980 CROMPOND ROAD
Practice Address - Street 2:THE WESTCHESTER MEDICAL PRACTICE PC
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:914-734-3600
Practice Address - Fax:914-734-3601
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY228776207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02524532Medicaid
NY223AL1Medicare ID - Type Unspecified
NYH94933Medicare UPIN