Provider Demographics
NPI:1104088301
Name:ATANASOVA, RUMYANA GEORGIEVA (MD)
Entity type:Individual
Prefix:DR
First Name:RUMYANA
Middle Name:GEORGIEVA
Last Name:ATANASOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-1137
Mailing Address - Country:US
Mailing Address - Phone:321-952-9696
Mailing Address - Fax:321-952-7937
Practice Address - Street 1:705 BLAKE AVE
Practice Address - Street 2:BLDG G
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7100
Practice Address - Country:US
Practice Address - Phone:321-633-6391
Practice Address - Fax:321-633-6441
Is Sole Proprietor?:No
Enumeration Date:2008-06-28
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH571AOtherMEDICARE ID - TYPE UNSPECIFIED
FL000429400Medicaid