Provider Demographics
NPI:1811004419
Name:MARKOWSKI-MARINO, ANDREA S (PA)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:S
Last Name:MARKOWSKI-MARINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CHAPEL ST.
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-789-3562
Mailing Address - Fax:203-867-5637
Practice Address - Street 1:1450 CHAPEL ST.
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-789-3562
Practice Address - Fax:203-867-5637
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000330363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004150637Medicaid
CT004150637Medicaid
CT970002197Medicare PIN
CT160002281Medicare ID - Type Unspecified