Provider Demographics
NPI:1477309573
Name:KRUSTEV, EUGENE ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ALEXANDER
Last Name:KRUSTEV
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 1:105-2422 ERLTON ST SW
Mailing Address - Street 2:
Mailing Address - City:CALGARY
Mailing Address - State:AB
Mailing Address - Zip Code:T253B6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4940 EASTERN AVE
Practice Address - Street 2:MYOSITIS CENTRE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:506-466-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program