Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086X0206X | Surgical Oncologist | 130880 | CA |
Y | 2086X0206X | Surgical Oncologist | 48864 | KY |
NPI | 1134320658 |
---|---|
Provider Name | Emily Fontenot Marcinkowski |
First Address | Lexington, KY 40536-7001 |
Second Address | Lexington, KY 40536-7001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 14/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
48864 | KENTUCKY MEDICAL LICENSE (01) | KY |