Individual
NICKOLAY PETER MARKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4881 SUGAR MAPLE DR, WPAFB, OH 45433-5529
(937) 255-9922
Mailing address
88MDG/SGHJ, 4881 SUGAR MAPLE DR., WRIGHT PATTERSON AFB, OH 45433
(937) 257-6529
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
35.134010
OH
208600000X
Surgery Physician
25622
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0376798
—
OH
01
—
390200000X
STUDENT IN AN ORGANIZED HEALTH CARE EDUCATION/TRAINING PROGRAM
TX
Enumeration date
06/27/2008
Last updated
03/01/2021
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