Provider Demographics
NPI:1609813930
Name:VAIL, MARIANNE E (PA)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:E
Last Name:VAIL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 13TH ST NE APT 305
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6316
Mailing Address - Country:US
Mailing Address - Phone:978-726-1206
Mailing Address - Fax:
Practice Address - Street 1:228 7TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4306
Practice Address - Country:US
Practice Address - Phone:202-698-0795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1174363A00000X
DC0110004232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP151001Medicare PIN