Provider Demographics
NPI:1508483132
Name:IGNACIO SUBIRA MEDINA, GIOVANNA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GIOVANNA
Middle Name:
Last Name:IGNACIO SUBIRA MEDINA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:GIOVANNA
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:1730 RACHAEL ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4272
Mailing Address - Country:US
Mailing Address - Phone:781-475-0736
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT221483207XX0005X
MA1016134207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery