Provider Demographics
NPI:1578856183
Name:KARAVOLIAS, MARIANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:
Last Name:KARAVOLIAS
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 1:3711 23RD AVE
Mailing Address - Street 2:ASTORIA PEDIATRICS
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1901
Mailing Address - Country:US
Mailing Address - Phone:718-721-6166
Mailing Address - Fax:718-721-7237
Practice Address - Street 1:3711 23RD AVE
Practice Address - Street 2:ASTORIA PEDIATRICS
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1901
Practice Address - Country:US
Practice Address - Phone:718-721-6166
Practice Address - Fax:718-721-7237
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270323208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program