Petkov, Theodore M

Petkov, Theodore M is an individual health care provider with primary practice located at 33-57 Harrison St , Johnson City NY 13790-2143. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Petkov, Theodore M can be contacted via phone (607) 763-6412.

Contact Information

Primary practice address
33-57 Harrison St Johnson City NY 13790-2143
Phone: (607) 763-6412
Fax: (607) 763-5854
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 165516 New York

Profile Details

NPI number 1184616575
LBN Legal business name Petkov, Theodore M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 22nd, 2005
Last updated Nov 19th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1184616575 NPPES
New York MEDICAID 01740303

Popular Providers