Provider Demographics
NPI:1124149547
Name:LOBANOV, PAVEL VLADIMIROVICH (MD)
Entity type:Individual
Prefix:
First Name:PAVEL
Middle Name:VLADIMIROVICH
Last Name:LOBANOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MAYO PL
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1228
Mailing Address - Country:US
Mailing Address - Phone:267-237-6220
Mailing Address - Fax:
Practice Address - Street 1:12 NEWBURYPORT RD
Practice Address - Street 2:
Practice Address - City:UPPER HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:19053-1556
Practice Address - Country:US
Practice Address - Phone:215-860-4110
Practice Address - Fax:267-295-8208
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 183296207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology