Healthcare Provider Details

I. General information

NPI: 1225006463
Provider Name (Legal Business Name): ALEX V HNATOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 182
ORLANDO FL
32804-4675
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 182
ORLANDO FL
32804-4675
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5857
  • Fax: 407-303-4782
Mailing address:
  • Phone: 407-303-5857
  • Fax: 407-303-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number201833
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME116765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: