MEDICARE: DR. ALEXEY MAXIMOVICH MARKELOV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	MD173983	OR
2	208200000X	Plastic Surgery Physician	71292	WI
3	208200000X	Plastic Surgery Physician	MD448418	PA
4	208600000X	Surgery Physician	MT192405	PA
5	208200000X	Plastic Surgery Physician	ME155748	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01700040	OTHER	OR	MEDICARE RAILROAD
4	R0000WFBTV	OTHER	OR	NORTH BEND MEDICAL CENTER GROUP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1407812365	OTHER	OR	NORTH BEND MEDICAL CENTER GROUP NPI
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851550867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXEY MAXIMOVICH MARKELOV MD

Provider Business Mailing Address
First Line	:	13618 W HILLSBOROUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-9638
Country	:	US
Telephone Number	:	813-709-8880
Fax Number	:	813-212-2099

Provider Business Practice Location Address
First Line	:	13618 W HILLSBOROUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-9638
Country	:	US
Telephone Number	:	813-709-8880
Fax Number	:	813-212-2099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2008
Last Update Date	:	10/11/2023

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