Provider Demographics
NPI:1598754533
Name:NISTOR, IRINA (MD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:NISTOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:
Other - Last Name:IORDANESCU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3114
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85271-3114
Mailing Address - Country:US
Mailing Address - Phone:480-425-5063
Mailing Address - Fax:480-425-5010
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-425-5000
Practice Address - Fax:480-945-6548
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ302322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ698996Medicaid
H69106Medicare UPIN
AZ69714Medicare PIN
AZ79074Medicare PIN
AZ698996Medicaid