Healthcare Provider Details

I. General information

NPI: 1871510446
Provider Name (Legal Business Name): STEFAN ALEXANDROV IANCHULEV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HOSPITAL CENTER BLVD
HILTON HEAD ISLAND SC
29926-2793
US

IV. Provider business mailing address

800 WASHINGTON ST TUFTS MEDICAL CENTER
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 843-681-6122
  • Fax:
Mailing address:
  • Phone: 617-636-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number235292
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number93710
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-55145
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: