Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 012135 | ME |
NPI | 1013959618 |
---|---|
Provider Name | Dr. Vassily Mihailoff |
First Address | Lyndhurst, NJ 07071-3604 |
Second Address | Biddeford, ME 04005-9428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 27/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002110 | BLUE CROSS BLUE SHIELD (01) | ME |
0104586Y0ME01 | BLUE CROSS BLUE SHIELD (01) | NH |
1042105 | AETNA (01) | ME |
125300000 | (05) | ME |
B86355 | (02) | ME |