Provider Demographics
NPI:1477517308
Name:MAVRAKAKIS, IRENE CHRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:CHRISTINA
Last Name:MAVRAKAKIS
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 1:211 EXECUTIVE DR STE 11
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3358
Mailing Address - Country:US
Mailing Address - Phone:302-731-2888
Mailing Address - Fax:302-731-7049
Practice Address - Street 1:285 BEISER BLVD STE 201
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7804
Practice Address - Country:US
Practice Address - Phone:302-731-2888
Practice Address - Fax:302-731-7049
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005628207L00000X, 208VP0014X
DEC10005628207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000936001Medicaid
DE198597ZBEMOtherMEDICARE
DE198597ZBEMOtherMEDICARE
DE00B931P65Medicare ID - Type UnspecifiedIND MEDICARE GROUP NUMBER