Provider Demographics
NPI:1467552729
Name:MARVIN CHADAB MD PA
Entity Type:Organization
Organization Name:MARVIN CHADAB MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHADAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-567-2774
Mailing Address - Street 1:6130 OXON HILL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3168
Mailing Address - Country:US
Mailing Address - Phone:301-567-2774
Mailing Address - Fax:301-567-4498
Practice Address - Street 1:6130 OXON HILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3168
Practice Address - Country:US
Practice Address - Phone:301-567-2774
Practice Address - Fax:301-567-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020477207N00000X
VA0101028798207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2803515OtherAETNA
MD252451100Medicaid
MD8084OtherGHMSI BLUE CROSS
MD252451100Medicaid
TX2803515OtherAETNA