Provider Demographics
NPI:1649276668
Name:SHCHELCHKOV, EVGENIY A (MD)
Entity type:Individual
Prefix:
First Name:EVGENIY
Middle Name:A
Last Name:SHCHELCHKOV
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 1:225 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2657
Mailing Address - Country:US
Mailing Address - Phone:724-941-6057
Mailing Address - Fax:
Practice Address - Street 1:225 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-2657
Practice Address - Country:US
Practice Address - Phone:724-941-6057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012354742084N0400X
PAMD4210602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA345616OtherANTHEM
VA7730501OtherAETNA
VA010044791Medicaid
VA10028259OtherOPTIMA/SENTARA
VA1649276668Medicaid
VA5927775OtherCIGNA
VA00X677C07Medicare PIN
102720Medicare UPIN
VA010044791Medicaid
VA1649276668Medicaid