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General NPI Number Information
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NPI Number | 1114297157
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Entity Type | Individual
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Provider Name | MARINELA Y INGILIZOVA MD
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Gender | Female
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Dates
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Enumeration Date | 01/09/2012
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 160 ROBBINS ST
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City | WATERBURY
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State | CT
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Zip | 06708-2652
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Country | US
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Telephone | 203-573-7284
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Fax | 203-573-7031
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Provider Business Mailing Address
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Address Line | 2500 MARYLAND RD STE 400
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1225
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Country | US
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Telephone | 215-481-4143
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Fax | 215-481-6790
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD452749
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | MD452749
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 55584
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 55584
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 255766
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License Number State | CT
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