Provider Demographics
NPI:1942476825
Name:MARBURGER, TESSA (MD)
Entity Type:Individual
Prefix:DR
First Name:TESSA
Middle Name:
Last Name:MARBURGER
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 1:1500 14TH ST W STE 300
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4079
Mailing Address - Country:US
Mailing Address - Phone:701-774-7500
Mailing Address - Fax:
Practice Address - Street 1:1500 14TH ST W STE 300
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4079
Practice Address - Country:US
Practice Address - Phone:701-774-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND138182084N0008X, 2084N0400X
ORMD1546722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1465176Medicaid