Provider Demographics
NPI:1174545107
Name:KOSTOV, FLAVIA ESTEVE (MD)
Entity type:Individual
Prefix:
First Name:FLAVIA
Middle Name:ESTEVE
Last Name:KOSTOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FLAVIA
Other - Middle Name:RAMOS
Other - Last Name:ESTEVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12100 WARWICK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2365
Practice Address - Country:US
Practice Address - Phone:757-534-5555
Practice Address - Fax:757-534-5567
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251176207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174545107Medicaid
VAVV4632AMedicare PIN
VAP01028368Medicare PIN