Provider Demographics
NPI:1417492034
Name:MARINA SHORES OB/GYN
Entity Type:Organization
Organization Name:MARINA SHORES OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OB/GYN PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LANI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-496-5000
Mailing Address - Street 1:2865 LYNNHAVEN DR
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1542
Mailing Address - Country:US
Mailing Address - Phone:757-496-5000
Mailing Address - Fax:
Practice Address - Street 1:2865 LYNNHAVEN DR
Practice Address - Street 2:SUITE 4A
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1542
Practice Address - Country:US
Practice Address - Phone:757-496-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256943207V00000X, 363L00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417492034OtherGROUP- NPI