Basic Information
| Provider Information | |||||||||
| NPI: | 1942269428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DINOLOV | ||||||||
| FirstName: | VLADIMIR | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2343 AARON ST | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339525305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416292900 | ||||||||
| FaxNumber: | 9416296143 | ||||||||
| Practice Location | |||||||||
| Address1: | 2343 AARON ST | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339525305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416292900 | ||||||||
| FaxNumber: | 9416296143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2006 | ||||||||
| LastUpdateDate: | 10/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME40321 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 051729100 | 05 | FL | MEDICAID | 17533 | 01 | FL | BCBS FL | OTHER |