Provider Demographics
NPI:1336249804
Name:ANTONOV, BORISLAV S (MD)
Entity type:Individual
Prefix:
First Name:BORISLAV
Middle Name:S
Last Name:ANTONOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1675
Mailing Address - Country:US
Mailing Address - Phone:302-645-3499
Mailing Address - Fax:302-644-4830
Practice Address - Street 1:424 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1462
Practice Address - Country:US
Practice Address - Phone:302-645-3525
Practice Address - Fax:302-645-3513
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006494208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1336249804OtherDIAMOND STATE MEDICAID
DEP00382719OtherRAILROAD MEDICARE
DE000000208393OtherUNISON HEALTH CARE-MCAID
DE1336249804Medicaid
DE1336249804OtherDE PHYSICIAN CARE-MCAID
DE522011HOSOtherBCBS OF DELAWARE-HOSPITAL
DE591343OtherCOVENTRY HEALTH CARE
DE522011HOSOtherBCBS OF DELAWARE-HOSPITAL
DE020936B86Medicare PIN