Individual
DR. MAXIM V MIROVSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 GRESHAM DR, 907 MEDICAL TOWER, NORFOLK, VA 23507-1901
(757) 627-7301
(757) 627-6238
Mailing address
6160 KEMPSVILLE CIRCLE, SUITE 302A, NORFOLK, VA 23502
(757) 466-9288
(757) 466-8954
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
0101840366
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689797847
—
VA
01
—
P00414462
RAILROAD MEDICARE
VA
Enumeration date
04/10/2007
Last updated
11/05/2007
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