Provider Demographics
NPI:1407891757
Name:CIAVARRA, GINA A (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:A
Last Name:CIAVARRA
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 1:301 E 17TH ST
Mailing Address - Street 2:6TH FLOOR RADIOLOGY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3804
Mailing Address - Country:US
Mailing Address - Phone:212-598-6373
Mailing Address - Fax:212-598-6125
Practice Address - Street 1:301 E 17TH ST
Practice Address - Street 2:6TH FLOOR RADIOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3804
Practice Address - Country:US
Practice Address - Phone:212-598-6373
Practice Address - Fax:212-598-6125
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2239762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY145F38Medicare UPIN
NYGC0804T610Medicare PIN
NY804T61Medicare PIN