Provider Demographics
NPI:1144240771
Name:PINA, ILEANA L (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:L
Last Name:PINA
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4216
Mailing Address - Country:US
Mailing Address - Phone:215-955-0899
Mailing Address - Fax:
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:215-955-0899
Practice Address - Fax:215-503-5650
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301116667207RC0000X
OH35-077623207RC0000X
PAMD039996E207RC0000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2169237Medicaid
OH2272693OtherAETNA
OH000000224316OtherUNISON
OH363914OtherWELLCARE
OH60058253OtherRAILROAD MEDICARE
OH741777OtherBUCKEYE
OH000000539435OtherANTHEM
OHPI4012731Medicare PIN
OH000000224316OtherUNISON
OH741777OtherBUCKEYE
PI4012732Medicare PIN