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General NPI Number Information
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NPI Number | 1033100565
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Entity Type | Individual
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Provider Name | ALEKSANDR KURBANOV MD
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Gender | Male
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 134 CAPITAL DR STE B
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-1349
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Country | US
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Telephone | 413-747-1817
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Fax | 413-747-6120
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Provider Business Mailing Address
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Address Line | PO BOX 366
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City | LUDLOW
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State | MA
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Zip | 01056-0366
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Country | US
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Telephone | 413-733-0010
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Fax | 413-930-2108
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 037499
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 152971
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License Number State | MA
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