Provider Demographics
NPI:1780034850
Name:RIVERA MARKELOVA, EKATHERINE (MD)
Entity type:Individual
Prefix:
First Name:EKATHERINE
Middle Name:
Last Name:RIVERA MARKELOVA
Suffix:
Gender:F
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:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-765-0020
Mailing Address - Fax:336-765-0581
Practice Address - Street 1:903 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5898
Practice Address - Country:US
Practice Address - Phone:336-765-0020
Practice Address - Fax:336-765-0581
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55040207RE0101X
NC2025-00845207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism