| Provider / Organization | NPI | Date Certified |
|---|---|---|
| VIKTOR VASILYEVICH FEDOROV | 1861855140 | 2024-09-07 |
Viktor Vasilyevich Fedorov is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1861855140. Registration indicates Viktor Vasilyevich Fedorov is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care) (Allopathic & Osteopathic Physicians, Surgery) (Surgery, ) (Specialist Network, ) (Surgery, Allopathic & Osteopathic Physicians)
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Viktor Vasilyevich Fedorov DO |
| Other Provider Name | Viktor Vasilyevich Stankovich |
| Practice Office Address | 317 WESTERN BLVD JACKSONVILLE, NC US |
| Practice Office Telephone | 9105772345 |
| Mailing Address | 540 AURORA PL HAMPSTEAD, NC 284430109 US |
| Business Telephone | 3193897572 |
| Code | Practice | License No State |
|---|---|---|
| 390200000X | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care | 218430
NC |
| 208600000X PRIMARY | Allopathic & Osteopathic Physicians Surgery Surgery Specialist Network Surgery Allopathic & Osteopathic Physicians | 2024-01637
NC |