Provider Demographics
NPI:1851550867
Name:MARKELOV, ALEXEY MAXIMOVICH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXEY
Middle Name:MAXIMOVICH
Last Name:MARKELOV
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 1:13618 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9638
Mailing Address - Country:US
Mailing Address - Phone:813-709-8880
Mailing Address - Fax:813-212-2099
Practice Address - Street 1:13618 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9638
Practice Address - Country:US
Practice Address - Phone:813-709-8880
Practice Address - Fax:813-212-2099
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD173983208200000X
WI71292208200000X
PAMD448418208200000X
PAMT192405208600000X
FLME155748208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR161133OtherNORTH BEND MEDICAL CENTER GROUP MEDICAID
ORP01700040OtherMEDICARE RAILROAD
OR1407812365OtherNORTH BEND MEDICAL CENTER GROUP NPI
ORR0000WFBTVOtherNORTH BEND MEDICAL CENTER GROUP MEDICARE
OR500698679Medicaid
ORR187364Medicare PIN