Provider Demographics
NPI:1669455622
Name:ORAHOVATS, DIMITER ALEXANDROV (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMITER
Middle Name:ALEXANDROV
Last Name:ORAHOVATS
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 1:5050 POWDERHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4800
Mailing Address - Country:US
Mailing Address - Phone:307-634-1311
Mailing Address - Fax:307-634-1271
Practice Address - Street 1:5050 POWDERHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4800
Practice Address - Country:US
Practice Address - Phone:307-634-1311
Practice Address - Fax:307-634-1271
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6836A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118412100Medicaid
G75980Medicare UPIN
WY118412100Medicaid
WYW24645Medicare PIN