Provider Demographics
NPI:1114987237
Name:MARINOVICH, ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MARINOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 AVENUE Z
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6322
Mailing Address - Country:US
Mailing Address - Phone:718-872-7373
Mailing Address - Fax:718-872-6772
Practice Address - Street 1:726 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6322
Practice Address - Country:US
Practice Address - Phone:718-872-7373
Practice Address - Fax:718-872-6772
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01793071Medicaid
NYWGW-841OtherUPIN
NYWGW-841OtherUPIN
NY30N341Medicare ID - Type Unspecified