Provider Demographics
NPI:1801089115
Name:JELNOV, VLADIMIR (MD)
Entity type:Individual
Prefix:MR
First Name:VLADIMIR
Middle Name:
Last Name:JELNOV
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 1:40 BEACON STREET EAST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3437
Mailing Address - Country:US
Mailing Address - Phone:603-524-1100
Mailing Address - Fax:603-528-0760
Practice Address - Street 1:40 BEACON STREET EAST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3437
Practice Address - Country:US
Practice Address - Phone:603-524-1100
Practice Address - Fax:603-528-0760
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH146552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3082440Medicaid