Provider Demographics
NPI:1942672217
Name:DOROKHOVA, INNA
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:DOROKHOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 LITTLETON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8374
Mailing Address - Country:US
Mailing Address - Phone:919-518-3946
Mailing Address - Fax:
Practice Address - Street 1:4108 LITTLETON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-8374
Practice Address - Country:US
Practice Address - Phone:919-518-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40327794171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40327794OtherDMA NC TRACKS