Provider Demographics
NPI:1902043144
Name:SEMENOVA, MARINA VLADIMIROVNA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:VLADIMIROVNA
Last Name:SEMENOVA
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 1:7 NORTH ST
Mailing Address - Street 2:508 APT
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5162
Mailing Address - Country:US
Mailing Address - Phone:413-822-0242
Mailing Address - Fax:
Practice Address - Street 1:7 NORTH ST
Practice Address - Street 2:508 APT
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5162
Practice Address - Country:US
Practice Address - Phone:413-822-0242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237835173000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine