Provider Demographics
NPI:1346262441
Name:MARROGI, AIZENHAWAR J (MD)
Entity Type:Individual
Prefix:DR
First Name:AIZENHAWAR
Middle Name:J
Last Name:MARROGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224-D CORNWALL STREET, NW, SUITE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:6736 CURRAN STREET, SUITE 2
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3803
Practice Address - Country:US
Practice Address - Phone:703-372-0787
Practice Address - Fax:703-712-7169
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053886171000000X
VA0101231650171000000X, 207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No171000000XOther Service ProvidersMilitary Health Care Provider
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1346262441Medicaid