Provider Demographics
NPI:1497173512
Name:MAGNINO, MICHELE ZERAH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ZERAH
Last Name:MAGNINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:ZERAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:3025 HAMAKER CT STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2237
Practice Address - Country:US
Practice Address - Phone:703-849-8036
Practice Address - Fax:703-204-3448
Is Sole Proprietor?:No
Enumeration Date:2014-04-05
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101266253207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology