Provider Demographics
NPI:1962505495
Name:MABERRY, ARJA A (MD PHD)
Entity Type:Individual
Prefix:
First Name:ARJA
Middle Name:A
Last Name:MABERRY
Suffix:
Gender:F
Credentials:MD PHD
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 403751
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384
Mailing Address - Country:US
Mailing Address - Phone:804-967-9225
Mailing Address - Fax:804-545-1686
Practice Address - Street 1:4355 INNSLAKE DRIVE
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-967-9225
Practice Address - Fax:804-545-5168
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235293207ZP0102X
NJ25MA05151200207ZP0102X
TXH3625207ZP0102X
KS0423152207ZP0102X
CT040582207ZP0102X
OK18760207ZP0102X
MOR9J68207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5001580OtherGHI
NY5001580OtherGHI