Provider Demographics
NPI:1235276593
Name:IVASHCHENKO, MARINA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:IVASHCHENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9898 ROSEMONT AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-4106
Mailing Address - Country:US
Mailing Address - Phone:303-799-7978
Mailing Address - Fax:303-790-4045
Practice Address - Street 1:9898 ROSEMONT AVE
Practice Address - Street 2:STE 104
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-4106
Practice Address - Country:US
Practice Address - Phone:303-799-7978
Practice Address - Fax:303-790-4045
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO48809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine