Provider Demographics
NPI:1407849136
Name:TARKINGTON, MARYANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:TARKINGTON
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:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101
Mailing Address - Country:US
Mailing Address - Phone:703-346-3321
Mailing Address - Fax:703-356-3739
Practice Address - Street 1:8503 ARLINGTON BLVD
Practice Address - Street 2:#310
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4628
Practice Address - Country:US
Practice Address - Phone:703-208-4200
Practice Address - Fax:703-876-1799
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041526208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
502651OtherNCPPO
440309OtherANTHEM MAIN OFFICE
839434OtherAETNA
290991OtherANTEHM SATELLITE OFFICE
B131/0006OtherCAREFIRST BCBS
839434OtherAETNA
757966D53Medicare ID - Type Unspecified