Provider Demographics
NPI:1932109816
Name:TSEPLAEV, EVGENY V (MD)
Entity Type:Individual
Prefix:
First Name:EVGENY
Middle Name:V
Last Name:TSEPLAEV
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 1:1 ELLIOT WAY
Mailing Address - Street 2:HOSPITALISTS
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3502
Mailing Address - Country:US
Mailing Address - Phone:603-663-2271
Mailing Address - Fax:603-663-2273
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:HOSPITALISTS
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-2271
Practice Address - Fax:603-663-2273
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46134207R00000X
NH17244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN172465800Medicaid
MN46134OtherMEDICAL LICENSE
MN46134OtherMEDICAL LICENSE