Individual
KRISTIYAN S. CHERVENKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
320 POMFRET ST, PUTNAM, CT 06260-1836
(860) 928-6541
Mailing address
1901 REDROCK DR, PFS DEPT, GALLUP, NM 87301-5683
(505) 863-7000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
47444
CT
207L00000X
Anesthesiology Physician
MD2004-0686
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10019724
LOVELACE HEALTH/SALUD
NM
05
—
20054726
—
NM
01
—
202000056
PRESBYTERIAN HEALTH/SALUD
NM
01
—
949224
AHCCCS
AZ
01
—
NM009W13
BC/BS
NM
01
—
QMYPR0068285
MOLINA
NM
Enumeration date
01/06/2006
Last updated
12/16/2022
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