Provider Demographics
NPI:1427099787
Name:AKBAROV, ALEC (MD)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:AKBAROV
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 1:2555 COURT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2134
Mailing Address - Country:US
Mailing Address - Phone:704-867-2141
Mailing Address - Fax:704-867-2308
Practice Address - Street 1:2555 COURT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2134
Practice Address - Country:US
Practice Address - Phone:704-867-2141
Practice Address - Fax:704-867-2308
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22635208G00000X
NC2013-00304208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE240960OtherMIDLANDS CHOICE
NE06246OtherBCBSNE
NEP00193879OtherRR
NEH96732Medicare UPIN
NE278452Medicare ID - Type Unspecified