Provider Demographics
NPI:1659614931
Name:MIRTCHEV, DIMITRE (MD)
Entity Type:Individual
Prefix:
First Name:DIMITRE
Middle Name:
Last Name:MIRTCHEV
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 1:1000 ASYLUM AVE STE 4304
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1704
Mailing Address - Country:US
Mailing Address - Phone:860-714-7509
Mailing Address - Fax:860-714-8038
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:SUITE 7.044
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-325-7080
Practice Address - Fax:713-512-2239
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT603302084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Single Specialty