MEDICARE: BORIS M DAROVSKY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	200700659	NC
2	207R00000X	Internal Medicine Physician	2007-00659	NC
3	207RH0003X	Hematology & Oncology Physician	200700659	NC
4	207RH0003X	Hematology & Oncology Physician	2007-00659	NC
5	207RH0003X	Hematology & Oncology Physician	0101237543	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1306831961	OTHER		NPID

General Provider Information

NPI Number	:	1306831961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BORIS M DAROVSKY MD

Provider Business Mailing Address
First Line	:	2232 WILBORN AVE STE D
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-1662
Country	:	US
Telephone Number	:	434-517-8140
Fax Number	:	434-575-1130

Provider Business Practice Location Address
First Line	:	2232 WILBORN AVE STE D
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-1662
Country	:	US
Telephone Number	:	434-517-8140
Fax Number	:	434-575-1130

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	01/13/2021

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