Andrew Marinchenko, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS039185 Issued in PA

Practice address

191 Presidential Blvd
W-4
Bala Cynwyd, PA 19004-1207

Phone

(610) 664-3636

Fax

(610) 664-5060

NPI assigned

Jun 29, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340928000000",
    "number": "1073877445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 E 239TH ST",
            "address_2": "1 E",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104701855",
            "telephone_number": "267-752-8760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 PRESIDENTIAL BLVD",
            "address_2": "W-4",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041207",
            "telephone_number": "610-664-3636",
            "fax_number": "610-664-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARINCHENKO",
        "first_name": "ANDREW",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-29",
        "last_updated": "2012-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS039185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.