Provider Demographics
NPI:1669447439
Name:PEICHEV, MARIO ATANASOV (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ATANASOV
Last Name:PEICHEV
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 1:1123 DOUGLAS PL
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1528
Mailing Address - Country:US
Mailing Address - Phone:516-804-3362
Mailing Address - Fax:
Practice Address - Street 1:3272 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4182
Practice Address - Country:US
Practice Address - Phone:718-406-9278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2008682080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH14011Medicare UPIN