Provider Demographics
NPI:1508982414
Name:MATURI, MARTHA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:MARIE
Last Name:MATURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7601 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2601
Mailing Address - Country:US
Mailing Address - Phone:703-642-1004
Mailing Address - Fax:703-642-3232
Practice Address - Street 1:7601 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2601
Practice Address - Country:US
Practice Address - Phone:703-642-1004
Practice Address - Fax:703-642-3232
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035502207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA047685ZBSMOtherPTAN
VAMA47685Medicare ID - Type Unspecified
VA047685ZBSMOtherPTAN