Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 070501 | GA |
N | 207RN0300X | Nephrologist | 200300065 | NC |
N | 207RN0300X | Nephrologist | 218412 | NY |
Y | 207RN0300X | Nephrologist | PT14398 | ND |
NPI | 1033189949 |
---|---|
Provider Name | Inna Malostovker |
First Address | Fargo, ND 58107-2168 |
Second Address | Fargo, ND 58102-3641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 03/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02732396 | (05) | NY |
H78259 | (02) | NC |