Provider Demographics
NPI:1780034850
Name:RIVERA MARKELOVA, EKATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:EKATHERINE
Middle Name:
Last Name:RIVERA MARKELOVA
Suffix:
Gender:F
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-9571
Mailing Address - Fax:606-408-6061
Practice Address - Street 1:1200 CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7575
Practice Address - Country:US
Practice Address - Phone:606-325-1894
Practice Address - Fax:606-325-9193
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY55040207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program