Provider Demographics
NPI:1316251929
Name:MARINA IVASHCHENKO, MD, PC
Entity type:Organization
Organization Name:MARINA IVASHCHENKO, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVASHCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-799-7978
Mailing Address - Street 1:9898 ROSEMONT AVE
Mailing Address - Street 2:BLDG 4, SUITE 104
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-4107
Mailing Address - Country:US
Mailing Address - Phone:303-799-7978
Mailing Address - Fax:303-790-4045
Practice Address - Street 1:9898 ROSEMONT AVE
Practice Address - Street 2:BLDG 4, SUITE 104
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-4107
Practice Address - Country:US
Practice Address - Phone:303-799-7978
Practice Address - Fax:303-790-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center