Provider Demographics
NPI:1083026694
Name:MARAGH DERMATOLOGY II LLC
Entity Type:Organization
Organization Name:MARAGH DERMATOLOGY II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNETTE HENDERSON
Authorized Official - Last Name:MARAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-858-0500
Mailing Address - Street 1:14995 SHADY GROVE RD
Mailing Address - Street 2:STE 150
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8726
Mailing Address - Country:US
Mailing Address - Phone:703-858-0500
Mailing Address - Fax:703-858-5155
Practice Address - Street 1:14995 SHADY GROVE RD
Practice Address - Street 2:STE 150
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8726
Practice Address - Country:US
Practice Address - Phone:703-858-0500
Practice Address - Fax:703-858-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-30
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241757207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H41101Medicare UPIN