Healthcare Provider Details

I. General information

NPI: 1235116534
Provider Name (Legal Business Name): MARINA A OPIDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 6TH AVE
ALTOONA PA
16602-1917
US

IV. Provider business mailing address

2918 6TH AVE
ALTOONA PA
16602-1917
US

V. Phone/Fax

Practice location:
  • Phone: 814-944-6055
  • Fax: 814-944-1912
Mailing address:
  • Phone: 814-944-6055
  • Fax: 814-944-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD038754L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: