Provider Demographics
NPI:1689797847
Name:MIROVSKI, MAXIM V (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIM
Middle Name:V
Last Name:MIROVSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6160 KEMPSVILLE CIRCLE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502
Mailing Address - Country:US
Mailing Address - Phone:757-466-9288
Mailing Address - Fax:757-466-8954
Practice Address - Street 1:400 GRESHAM DR
Practice Address - Street 2:907 MEDICAL TOWER
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1901
Practice Address - Country:US
Practice Address - Phone:757-627-7301
Practice Address - Fax:757-627-6238
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-11-05
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Provider Licenses
StateLicense IDTaxonomies
VA0101840366207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1689797847Medicaid
VAP00414462OtherRAILROAD MEDICARE
H05790Medicare UPIN
VA1689797847Medicaid