Provider Demographics
NPI:1922824044
Name:PUCHKOV, BOGDAN
Entity type:Individual
Prefix:
First Name:BOGDAN
Middle Name:
Last Name:PUCHKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 AUTUMN LAKES CT APT 205
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-5164
Mailing Address - Country:US
Mailing Address - Phone:757-266-6944
Mailing Address - Fax:
Practice Address - Street 1:1105 AUTUMN LAKES CT APT 205
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-5164
Practice Address - Country:US
Practice Address - Phone:757-266-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter