Provider Demographics
NPI:1326259532
Name:MA, MARINA K S (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:K S
Last Name:MA
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 1:4 LAND RE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1735
Mailing Address - Country:US
Mailing Address - Phone:585-368-6620
Mailing Address - Fax:
Practice Address - Street 1:4 LAND RE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1735
Practice Address - Country:US
Practice Address - Phone:585-368-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03248551Medicaid
NYJ400027346/GRPBA0017Medicare PIN
NYJ400027348/GRP70008AMedicare PIN