Provider Demographics
NPI:1497290266
Name:STANICZENKO, ANNA P (MD MSC)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:P
Last Name:STANICZENKO
Suffix:
Gender:F
Credentials:MD MSC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:PORAY
Other - Last Name:GODDU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:733 N BROADWAY STE 147
Mailing Address - Street 2:THE JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1832
Mailing Address - Country:US
Mailing Address - Phone:410-955-3080
Mailing Address - Fax:
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program