Provider Demographics
NPI:1578851689
Name:ATANELOV, LEVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEVAN
Middle Name:
Last Name:ATANELOV
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 1:9199 REISTERSTOWN RD STE 101B
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:443-898-8160
Mailing Address - Fax:443-898-8916
Practice Address - Street 1:9199 REISTERSTOWN RD STE 101B
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:443-898-8160
Practice Address - Fax:443-898-8916
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD78960208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP01628953OtherRAILROAD MEDICARE
MD097425100Medicaid
MD097425100Medicaid