Provider Demographics
NPI:1528018736
Name:KRAVETS, MARINA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KRAVETS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:MATUSOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:41 UNIVERSITY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:240 MIDDLETOWN BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-750-2300
Practice Address - Fax:215-750-2315
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067289L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP01193474OtherRAILROAD MEDICARE
PA1638261OtherHIGHMARK BLUE SHIELD
PA30214731OtherKEYSTONE FIRST
PAP012605OtherGATEWAY
PA8328992OtherCIGNA PA
PA0019103410004Medicaid
PA2313072000OtherKEYSTONE IBC
PA7378654OtherAETNA
PA7378654OtherAETNA
G84349Medicare UPIN