Provider Demographics
NPI:1215101910
Name:IWAMOTO, MARIAN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:IWAMOTO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E LINCOLN AVE
Mailing Address - Street 2:RY34-A500
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-0900
Mailing Address - Country:US
Mailing Address - Phone:732-594-4947
Mailing Address - Fax:908-823-3620
Practice Address - Street 1:126 E LINCOLN AVE
Practice Address - Street 2:RY34-A500
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-0900
Practice Address - Country:US
Practice Address - Phone:732-594-4947
Practice Address - Fax:908-823-3620
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07432200207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology