Provider Demographics
NPI:1740222439
Name:OLIVARI, MARJORIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:A
Last Name:OLIVARI
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 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-7019
Practice Address - Country:US
Practice Address - Phone:434-243-9466
Practice Address - Fax:434-243-9499
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD14020207Q00000X
VA0101276754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1740222439Medicaid
E47364Medicare UPIN
MEMM611001Medicare PIN
ME30217099Medicaid
MEMM6110Medicare PIN