NPIMap

Ivan John Christov Nicolov, M.D.

Individual provider Active NPI Hospice and Palliative Medicine (Family Medicine) Physician · Pine Hill, NM

NPI 1649488255 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1649488255
Entity type
Individual (NPI type 1)
Primary specialty
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X
License
MD20060115 (NM)
Practice address
Bia Rte 125
Pine Hill, NM 87357
Phone
(505) 775-3271
Fax
(505) 775-3930
NPI assigned
May 18, 2007
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD20060115NMMDHospice and Palliative Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ramah Navajo School Board, Inc Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X MD20060115 NM Yes

Addresses

Primary practice location

Bia Rte 125
Pine Hill, NM 87357

Mailing address

Bia Rte 125
310
Pine Hill, NM 87357
Phone (505) 775-3271

Other providers in Pine Hill, NM

All providers in Pine Hill, NM · Hospice and Palliative Medicine (Family Medicine) Physician in New Mexico

Sources for this page

Verify at the official NPI Registry.