Provider Demographics
NPI:1982986576
Name:GAVRILINA, ANNA VLADIMIROVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:VLADIMIROVNA
Last Name:GAVRILINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:ORELLANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:210 W DIVISION ST APT 9
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-1575
Mailing Address - Country:US
Mailing Address - Phone:630-805-2662
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2342
Practice Address - Country:US
Practice Address - Phone:315-464-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYASO552489571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine