MEDICARE: ANNA MARINOVICH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	207092	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	WGW-841	OTHER	NY	UPIN

General Provider Information

NPI Number	:	1114987237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MARINOVICH M.D.

Provider Business Mailing Address
First Line	:	726 AVENUE Z
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6322
Country	:	US
Telephone Number	:	718-872-7373
Fax Number	:	718-872-6772

Provider Business Practice Location Address
First Line	:	726 AVENUE Z
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6322
Country	:	US
Telephone Number	:	718-872-7373
Fax Number	:	718-872-6772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	08/21/2008

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