Provider Demographics
NPI:1447542006
Name:BUHTOIAROVA, TATIANA NIKOLAEVNA (MD)
Entity type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:NIKOLAEVNA
Last Name:BUHTOIAROVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TATIANA
Other - Middle Name:NIKOLAEVNA
Other - Last Name:FITISENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18453 CLARE CT
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-1056
Mailing Address - Country:US
Mailing Address - Phone:908-400-8685
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-5672
Practice Address - Country:US
Practice Address - Phone:164-442-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.128372207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program