MEDICARE: DR. ANNA LEONIDOVNA MARINA 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD60019992	WA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD162534	OR

General Provider Information

NPI Number	:	1780869032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA LEONIDOVNA MARINA M.D.

Provider Business Mailing Address
First Line	:	2111 EXCHANGE ST
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-3329
Country	:	US
Telephone Number	:	503-324-4321
Fax Number	:

Provider Business Practice Location Address
First Line	:	2158 EXCHANGE ST STE 205
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-3307
Country	:	US
Telephone Number	:	503-338-4531
Fax Number	:	503-338-4532

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

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	02/15/2022

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