IGOR VIKTOROVICH AKSENOV (NPI# 1699854224) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699854224 |
| Entity Type | Individual |
| Full Name | IGOR VIKTOROVICH AKSENOV |
| Credential | M.D. |
| Practice Address |
4700 Waters Ave Ste 507 Savannah GA 31404 |
| Mailing Address |
4700 Waters Ave Ste 507 Savannah GA 31404-6220 |
| Practice Telephone | 9123504750 |
| Practice Fax Number | 9123504751 |
| Mailing Telephone | 9123504750 |
| Mailing Fax Number | 9123504751 |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2018-08-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 062644 | GA | Allopathic & Osteopathic Physicians |
| N | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
062644 | GA | Allopathic & Osteopathic Physicians |
| N | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
ME94813 | FL | Allopathic & Osteopathic Physicians |
| Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
062644 | GA | Allopathic & Osteopathic Physicians |
| N | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
ME94813 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AMERIGROUP | 01286490 | 01 | |
| GA | WELLCARE | 518768 | 01 |
| GA | 321479371B | 05 | |
| SC | G62644 | 05 | |
| GA | 321479371A | 05 | |
| GA | RAILROAD MEDICARE | P00733491 | 01 |
| Street Address |
4700 WATERS AVE STE 507 |
| City | SAVANNAH |
| State | GA |
| Zip Code | 31404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457341778 | Jon Robert Beacher | Internal Medicine | 4700 Waters Ave Ste 507, Savannah, GA 31404-6220 | 2005-10-27 |
| 1598307324 | Matthew Dillon Melton | Nurse Practitioner | 4700 Waters Ave Ste 507, Savannah, GA 31404-6220 | 2019-10-14 |
| 1629620901 | Ashley Spring Edwards | Nurse Practitioner | 4700 Waters Ave Ste 507, Savannah, GA 31404-6220 | 2019-07-16 |
| 1750744249 | Heather Zimmerman | Registered Nurse | 4700 Waters Ave Ste 507, Savannah, GA 31404 | 2016-04-01 |
| 1427342070 | Sarah Ellen Elza Stephens | Internal Medicine | 4700 Waters Ave Ste 507, Savannah, GA 31404 | 2011-05-31 |
| 1275859050 | Ashley M. Wanager | Nurse Practitioner | 4700 Waters Ave Ste 507, Savannah, GA 31404 | 2010-04-19 |
| 1023278967 | Domenick J Roma | Internal Medicine | 4700 Waters Ave Ste 507, Savannah, GA 31404 | 2008-06-13 |
| 1467677914 | Jason R Mcclune | Internal Medicine | 4700 Waters Ave Ste 507, Savannah, GA 31404 | 2007-04-17 |
| 1265595847 | Julia F. Johnson | Family Medicine | 4700 Waters Ave Ste 507, Savannah, GA 31404-6220 | 2006-12-18 |
| 1841301140 | Kathia A. Ortiz-cantillo | Internal Medicine | 4700 Waters Ave Ste 507, Savannah, GA 31404-6220 | 2006-08-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043864580 | Carli A Boatright | Registered Nurse | 4750 Waters Ave Suite 206, Savannah, GA 31404 | 2019-08-01 |
| 1619530573 | Morgan Johnson | Student in an Organized Health Care Education/Training Program | Memorial Health University Medical Center, 4700 Waters Ave, Savannah, GA 31404 | 2019-04-17 |
| 1477050243 | Kevin Timperman | Student in an Organized Health Care Education/Training Program | 4700 Waters Avenus, Surgery Residency Program, Mhumc, Savannah, GA 31404 | 2018-04-09 |
| 1376048959 | Nina Jo Paletta | Student in an Organized Health Care Education/Training Program | Memorial University Medical Center, 4700 Waters Ave., Savannah, GA 31404 | 2018-03-27 |
| 1972036200 | Jose Adrian Lara Gonzalez | Student in an Organized Health Care Education/Training Program | 4700 Waters Ave, Memorial University Medical Center, Internal Medicine Residency Program, Savannah, GA 31404 | 2017-04-04 |
| 1407210396 | Lexie Hester Vaughn | Student in an Organized Health Care Education/Training Program | 1250 East 66th St, Savannah, GA 31404 | 2016-04-07 |
| 1336503291 | Miles Love | Student in an Organized Health Care Education/Training Program | 1250 East 66th Street, Savannah, GA 31404 | 2016-04-07 |
| 1134536881 | David Patch | Specialist/Technologist | Pediatric Residency Program, Memorial University, Medical Center 4700 Waters Avenue, Savannah, GA 31404 | 2014-07-15 |
| 1962846683 | Alan Danilo Zevallos | Internal Medicine | 4700 Waters Avenue, University Medical Center, Internal Medicine Residency Program, Memorial Health, Savannah, GA 31404 | 2013-04-24 |
| 1730446394 | Joshua Ryan Fann | Prosthetist | 3840 Waters Ave, Savannah, GA 31404 | 2012-04-19 |
| Find all providers in zip 31404 | ||||
| Taxonomy Code | 207RP1001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Pulmonary Disease |
| An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235659814 | Southeast Lung & Criticial Care Specialists, PC | Internal Medicine | 5356 Reynolds St Ste 303, Savannah, GA 31405-6018 | 2017-06-23 |
| 1770989154 | Southeast Lung & Critical Care Specialists, PC | Internal Medicine | 800 East 68th Street, Landmark Hospital, Savannah, GA 31405 | 2014-11-12 |
| 1174780472 | Robert James Dibenedetto | Internal Medicine | 8 Cedar Marsh Retreat, Savannah, GA 31411-2922 | 2008-05-22 |
| 1255489019 | Masood Ahmed | Internal Medicine | 5356 Reynolds Street, Suite 303, Savannah, GA 31405-6016 | 2007-01-08 |
| 1982769568 | Savannah Medical Specialists PC | Internal Medicine | 5354 Reynolds St Ste 505, Savannah, GA 31405-6012 | 2006-12-26 |
| 1689672438 | Patricia Ann Costanzo | Internal Medicine | 4 Sea Oats Ln, Savannah, GA 31411-3102 | 2005-07-14 |
| 1972901395 | Southeast Lung & Critical Care Specialists, PC | Internal Medicine | 5354 Reynolds St, Suite #318, Savannah, GA 31405-6007 | 2014-12-17 |
| 1447675905 | Southeast Lung & Critical Care Specialists, PC | Internal Medicine | 340 Hodgson Ct, Suite #2, Savannah, GA 31406-1520 | 2014-02-20 |
| 1194153874 | Southeast Lung & Critical Care Specialists, PC | Internal Medicine | 11800 Abercorn St, Savannah, GA 31419-1908 | 2013-10-16 |
| 1205193398 | Southeast Lung & Critical Care Specialists, PC | Internal Medicine | 11706 Mercy Blvd, Bldg #4, Savannah, GA 31419-1751 | 2012-04-13 |
| Find all providers in SAVANNAH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.