Provider Demographics
NPI:1033121611
Name:IONAS, ROXANA (MD)
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:
Last Name:IONAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROXANA
Other - Middle Name:
Other - Last Name:DRAGHICI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1416 CROWN DR
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2548
Mailing Address - Country:US
Mailing Address - Phone:660-627-5757
Mailing Address - Fax:660-627-5802
Practice Address - Street 1:402 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3407
Practice Address - Country:US
Practice Address - Phone:660-627-2229
Practice Address - Fax:660-627-2233
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022612208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201222700Medicaid
MO926061740Medicare PIN
MOI62389Medicare UPIN