Provider Demographics
NPI:1265470306
Name:CHEKOV, SERGEI V (MD)
Entity type:Individual
Prefix:
First Name:SERGEI
Middle Name:V
Last Name:CHEKOV
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 1:9892 BUSTLETON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2138
Mailing Address - Country:US
Mailing Address - Phone:215-897-9090
Mailing Address - Fax:215-897-9094
Practice Address - Street 1:9892 BUSTLETON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2138
Practice Address - Country:US
Practice Address - Phone:215-897-9090
Practice Address - Fax:215-897-9094
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101366436Medicaid
PAI35221Medicare UPIN
PA092832Medicare ID - Type Unspecified