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NPI Code Detail

MEDICARE: MRS. MARINA SEMENOVNA KYAZIMOVA PA-C

MEDICARE: MRS. MARINA SEMENOVNA KYAZIMOVA PA-C
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
1363A00000XPhysician Assistant103425NC

General Provider Information

NPI Number : 1265530877
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARINA SEMENOVNA KYAZIMOVA PA-C
Provider Business Mailing Address
First Line : 3803 N ELM ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-2593
Country : US
Telephone Number : 336-540-7067
Fax Number : 336-540-6756
Provider Business Practice Location Address
First Line : 3803 N ELM ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27455-2593
Country : US
Telephone Number : 336-540-7067
Fax Number : 888-882-3919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 11/03/2009

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