Provider Demographics
NPI:1629272935
Name:PEREZ FOURNIER, MARINA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:PEREZ FOURNIER
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 1:9500 EUCLID AVE
Mailing Address - Street 2:CLEVELAND CLINIC /NEONATOLOGY M31
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-513-4778
Mailing Address - Fax:216-444-7625
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:CLEVELAND CLINIC /NEONATOLOGY M31
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-513-4778
Practice Address - Fax:216-444-7625
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57009867208000000X
ARE-65412080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184746001Medicaid
AR5AG71Medicare PIN