Provider Demographics
NPI:1609868785
Name:DIOUKALOVA, OLGA A (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:A
Last Name:DIOUKALOVA
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 1:1915 OCEAN AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6801
Mailing Address - Country:US
Mailing Address - Phone:718-951-0333
Mailing Address - Fax:718-951-3774
Practice Address - Street 1:1915 OCEAN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6801
Practice Address - Country:US
Practice Address - Phone:718-951-0333
Practice Address - Fax:718-951-3774
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214274207R00000X
FLME81796207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01977628Medicaid
NY01977628Medicaid
NY59N661Medicare ID - Type Unspecified
NY59N661Medicare PIN