Provider Demographics
NPI:1871715524
Name:IONITA, MARCEL A (MD, PHD)
Entity type:Individual
Prefix:
First Name:MARCEL
Middle Name:A
Last Name:IONITA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:408 MANATEE AVE E STE 2
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1135
Practice Address - Country:US
Practice Address - Phone:941-748-1331
Practice Address - Fax:941-746-2803
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437944207Q00000X
FLME137422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023402290001Medicaid
PA160589Medicare PIN
PA228983YEBKMedicare PIN
PA1023402290001Medicaid
PA228983YUNMMedicare PIN
G55216Medicare UPIN
PAP00813443Medicare PIN