Healthcare Provider Details

I. General information

NPI: 1235143223
Provider Name (Legal Business Name): DIMITRI D. MARKOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 9TH ST SUITE 500
PHILADELPHIA PA
19107-6810
US

IV. Provider business mailing address

211 S 9TH ST SUITE 500
PHILADELPHIA PA
19107-6810
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6175
  • Fax: 215-955-9783
Mailing address:
  • Phone: 215-955-6175
  • Fax: 215-955-9783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD420226
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberMD420226
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: