Provider Demographics
NPI:1508812702
Name:RESTAINO, IRENE G (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:G
Last Name:RESTAINO
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:PO BOX 79137
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0137
Mailing Address - Country:US
Mailing Address - Phone:757-668-7200
Mailing Address - Fax:757-668-9691
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7244
Practice Address - Fax:757-668-9814
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010485922080P0210X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006721966Medicaid
PA0012193300005Medicaid
MD698091100Medicaid
WV9840886000Medicaid
E75927Medicare UPIN
WV9840886000Medicaid
PA0012193300005Medicaid