Provider Demographics
NPI:1265407704
Name:AQUINO, ROWENA S (MD)
Entity type:Individual
Prefix:DR
First Name:ROWENA
Middle Name:S
Last Name:AQUINO
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:PO BOX 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-953-4700
Mailing Address - Fax:
Practice Address - Street 1:2215 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-1033
Practice Address - Country:US
Practice Address - Phone:502-772-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052881A208000000X
KY38255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200293810Medicaid
IN200293810Medicaid
KY0795622Medicare PIN
940540OOOOMedicare ID - Type Unspecified
KY0637749Medicare PIN
H27905Medicare UPIN
KY0538683Medicare PIN
KY0538783Medicare PIN
KY0538498Medicare PIN
KY00714003Medicare PIN