Provider Demographics
NPI:1023286531
Name:NOSOV, OLEXANDR S (MD, SA-C)
Entity type:Individual
Prefix:MR
First Name:OLEXANDR
Middle Name:S
Last Name:NOSOV
Suffix:
Gender:M
Credentials:MD, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75014
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-0014
Mailing Address - Country:US
Mailing Address - Phone:864-234-9900
Mailing Address - Fax:864-254-9459
Practice Address - Street 1:209 PATEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3581
Practice Address - Country:US
Practice Address - Phone:864-234-9900
Practice Address - Fax:864-254-9459
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC08-109246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist