Provider Demographics
NPI:1841412145
Name:GEORGIEV, ANTON LYUBOMIROV (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTON
Middle Name:LYUBOMIROV
Last Name:GEORGIEV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-2316
Mailing Address - Country:US
Mailing Address - Phone:570-759-5453
Mailing Address - Fax:
Practice Address - Street 1:701 E 16TH ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2316
Practice Address - Country:US
Practice Address - Phone:570-759-5453
Practice Address - Fax:570-759-3473
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015594208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery