Provider Demographics
NPI:1871719542
Name:SUPE-MARKOVINA, KATARINA (MD)
Entity type:Individual
Prefix:DR
First Name:KATARINA
Middle Name:
Last Name:SUPE-MARKOVINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATARINA
Other - Middle Name:
Other - Last Name:SUPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:STONY BROOK CHILDRENS HOSPITAL
Mailing Address - Street 2:HOSPITAL LEVEL T-11, ROOM 060
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8111
Mailing Address - Country:US
Mailing Address - Phone:631-444-7884
Mailing Address - Fax:631-444-8968
Practice Address - Street 1:STONY BROOK CHILDRENS HOSPITAL
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8111
Practice Address - Country:US
Practice Address - Phone:631-444-7884
Practice Address - Fax:631-444-8968
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2347402080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology