Provider Demographics
NPI:1538389390
Name:LYUBENOVA-IVANOVA, MARIYA LYUBOMIROVA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIYA
Middle Name:LYUBOMIROVA
Last Name:LYUBENOVA-IVANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIYA
Other - Middle Name:LYUBOMIROVA
Other - Last Name:IVANOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 3016B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-6339
Mailing Address - Fax:314-251-4564
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 3016B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-6339
Practice Address - Fax:314-251-4564
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005016635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine