Basic Information
| Provider Information | |||||||||
| NPI: | 1689669269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOSHNAKOV | ||||||||
| FirstName: | TZVETALIN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 S 2ND ST STE 2F | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041612 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 361 ALEXANDER SPRING RD | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172318772 | ||||||||
| FaxNumber: | 7172318435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 01/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD072903L | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | MD166845 | OR | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MD072903L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001836825 | 05 | PA | MEDICAID | P003028 | 01 | PA | GATEWAY | OTHER | 1561071 | 01 | PA | GATEWAY | OTHER | 550287 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 30141854 | 01 | PA | AMERIHEALTH MERCY - WMG | OTHER | 30140891 | 01 | PA | AMERIHEALTH MERCY - THFP | OTHER | 721645 | 01 | PA | UPMC | OTHER |