Provider Demographics
NPI:1134280449
Name:VERNALIS, MARINA NIKKI (DO)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:NIKKI
Last Name:VERNALIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WRAMC 2J38
Mailing Address - Street 2:6900 GEORGIA AVE,NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307-0001
Mailing Address - Country:US
Mailing Address - Phone:202-782-1555
Mailing Address - Fax:
Practice Address - Street 1:2 WRAMC # 2J38
Practice Address - Street 2:6900 GEORGIA AVE,NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC20931207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC20OtherALLOPATHIC OSTEOPATHIC PH