Provider Demographics
NPI:1710399563
Name:BOBROVNIKOV, VLADIM (MD)
Entity Type:Individual
Prefix:DR
First Name:VLADIM
Middle Name:
Last Name:BOBROVNIKOV
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 1:7535 CARPENTER FIRE STATION RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8969
Mailing Address - Country:US
Mailing Address - Phone:919-775-2304
Mailing Address - Fax:
Practice Address - Street 1:1140 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4161
Practice Address - Country:US
Practice Address - Phone:919-775-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN57418207V00000X
GA79822207V00000X
390200000X
NC2019-01942207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program