Provider Demographics
NPI:1598967317
Name:GHEORGHIU, IOANA ANDREIA (MD)
Entity Type:Individual
Prefix:
First Name:IOANA
Middle Name:ANDREIA
Last Name:GHEORGHIU
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 1:815 POLLARD RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1438
Mailing Address - Country:US
Mailing Address - Phone:408-871-3289
Mailing Address - Fax:
Practice Address - Street 1:815 POLLARD RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1438
Practice Address - Country:US
Practice Address - Phone:408-871-3289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089704207R00000X
CAA116582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1101111322OtherBLUE CROSS PIN
MI5200846Medicaid
MI0M3535115Medicare PIN
MI5200846Medicaid