Provider Demographics
NPI:1831400134
Name:MARINA IVASHCHENKO, MD, PC
Entity type:Organization
Organization Name:MARINA IVASHCHENKO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVASHCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-798-4404
Mailing Address - Street 1:9898 ROSEMONT AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-4107
Mailing Address - Country:US
Mailing Address - Phone:303-798-4404
Mailing Address - Fax:303-468-0393
Practice Address - Street 1:9898 ROSEMONT AVE STE 103
Practice Address - Street 2:
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-4107
Practice Address - Country:US
Practice Address - Phone:303-798-4404
Practice Address - Fax:303-468-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty