Provider Demographics
NPI:1902821606
Name:MARVIN, MICHAEL ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:MARVIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 A OAK LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1633
Mailing Address - Country:US
Mailing Address - Phone:434-572-1444
Mailing Address - Fax:434-575-8159
Practice Address - Street 1:405A OAK LN
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1633
Practice Address - Country:US
Practice Address - Phone:434-572-1444
Practice Address - Fax:434-575-8159
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000792213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T95735Medicare UPIN