Provider Demographics
NPI:1821004516
Name:MARKOV, MARKO GEORGIEV (MD)
Entity Type:Individual
Prefix:
First Name:MARKO
Middle Name:GEORGIEV
Last Name:MARKOV
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 1:1180 ROSECRANS ST STE 104-540
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2660
Mailing Address - Country:US
Mailing Address - Phone:480-760-5862
Mailing Address - Fax:
Practice Address - Street 1:2185 CITRACADO PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4159
Practice Address - Country:US
Practice Address - Phone:480-760-5862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35882207R00000X
CAA93368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ120133Medicaid
AZP00348212Medicare PIN
AZ120133Medicaid
AZI60995Medicare UPIN