Provider Demographics
NPI:1689669269
Name:BOSHNAKOV, TZVETALIN A (MD)
Entity Type:Individual
Prefix:
First Name:TZVETALIN
Middle Name:A
Last Name:BOSHNAKOV
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 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:361 ALEXANDER SPRING RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015
Practice Address - Country:US
Practice Address - Phone:717-231-8772
Practice Address - Fax:717-231-8435
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072903L208M00000X, 207R00000X
ORMD166845208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001836825Medicaid
PAP003028OtherGATEWAY
PA1561071OtherGATEWAY
PA550287OtherHIGHMARK BLUE SHIELD
PA30141854OtherAMERIHEALTH MERCY - WMG
PA30140891OtherAMERIHEALTH MERCY - THFP
PA721645OtherUPMC
PAB0550287Medicare ID - Type Unspecified
PAP01226285Medicare PIN
PA1561071OtherGATEWAY
PAH30678Medicare UPIN
PA001836825Medicaid
PA044866FLTMedicare PIN