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General NPI Number Information
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NPI Number | 1871642835
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Entity Type | Individual
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Provider Name | JEAN IVANOV TCHERVENKOV M.D
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7395 PLACE MALRAUX
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City | BROSSARD
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State | QUEBEC
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Zip | J4Y 1S5
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Country | CA
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Telephone | 450-443-0973
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Fax | 514-843-1434
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Provider Business Mailing Address
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Address Line | 7395 PLACE MALRAUX
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City | BROSSARD
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State | QUEBEC
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Zip | J4Y 1S5
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Country | CA
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Telephone | 450-443-0973
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Fax | 514-843-1434
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0420010525
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License Number State | VT
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