Provider Demographics
NPI:1164425955
Name:MARIN, EILEEN M (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:MARIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 GEORGIA AVE
Mailing Address - Street 2:STE 306
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5020
Mailing Address - Country:US
Mailing Address - Phone:301-681-6055
Mailing Address - Fax:301-681-9670
Practice Address - Street 1:10301 GEORGIA AVE
Practice Address - Street 2:STE 306
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:301-681-6055
Practice Address - Fax:301-681-9670
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0040589207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
007695A77Medicare ID - Type Unspecified
H05559Medicare UPIN