Provider Demographics
NPI:1386639268
Name:IONITA, MARINA RUXANDRA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:RUXANDRA
Last Name:IONITA
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 1:28 CRESCENT ST
Mailing Address - Street 2:SUITE #A101
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-4820
Mailing Address - Fax:860-358-8661
Practice Address - Street 1:520 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4700
Practice Address - Country:US
Practice Address - Phone:860-344-1801
Practice Address - Fax:860-358-8657
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042617207R00000X, 207RG0300X, 207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N366OtherBCBS
TX209688501Medicaid
ARP00355193OtherRAILROAD MEDICARE1
TX209688503Medicaid
CT001426172Medicaid
TX209688502Medicaid
AR05100016910OtherQUALCHOICE
AR5N366Medicare PIN
ARP00355193OtherRAILROAD MEDICARE1
CTD400071143Medicare PIN
TX209688502Medicaid
TX209688501Medicaid
TX8L24177Medicare PIN