Provider Demographics
NPI:1780869032
Name:MARINA, ANNA LEONIDOVNA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:LEONIDOVNA
Last Name:MARINA
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 1:2111 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3329
Mailing Address - Country:US
Mailing Address - Phone:503-324-4321
Mailing Address - Fax:
Practice Address - Street 1:2158 EXCHANGE ST STE 205
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3307
Practice Address - Country:US
Practice Address - Phone:503-338-4531
Practice Address - Fax:503-338-4532
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60019992207RE0101X
ORMD162534207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01038752OtherRAILROAD MEDICARE
WA0288508OtherDEPT OF LABOR AND INDUSTRIES
WA8910474Medicare PIN
WA8907197Medicare PIN