Provider Demographics
NPI:1235116534
Name:OPIDA, MARINA A (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:A
Last Name:OPIDA
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 1:2918 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1917
Mailing Address - Country:US
Mailing Address - Phone:814-944-6055
Mailing Address - Fax:814-944-1912
Practice Address - Street 1:2918 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1917
Practice Address - Country:US
Practice Address - Phone:814-944-6055
Practice Address - Fax:814-944-1912
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038754L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020322OtherGATEWAY
PA104310OtherUPMC
PA61957OtherTHREE RIVERS-UNISON
PA0007728210002Medicaid
PA402801OtherHIGHMARK
B41241Medicare UPIN
402801EJHMedicare ID - Type Unspecified