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General NPI Number Information
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NPI Number | 1871922534
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Entity Type | Organization
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Legal Business Name | SERGEI CHEKOV MD PC
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 05/08/2014
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Provider Practice Location Address
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Address Line | 9892 BUSTLETON AVE SUITE 103
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City | PHILADELPHIA
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State | PA
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Zip | 19115-2184
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Country | US
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Telephone | 215-897-9090
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Fax | 215-897-9094
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Provider Business Mailing Address
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Address Line | 9892 BUSTLETON AVE SUITE 103
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City | PHILADELPHIA
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State | PA
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Zip | 19115-2184
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Country | US
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Telephone | 215-897-9090
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Fax | 215-897-9094
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SERGEI CHEKOV
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Credential | MD
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Telephone | 215-897-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD418486
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License Number State | PA
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