Provider Demographics
NPI:1295754042
Name:MARTINEZ, MARINA I (MD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:I
Last Name:MARTINEZ
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 1:1625 N GEORGE MASON DR
Mailing Address - Street 2:STE 465
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3683
Mailing Address - Country:US
Mailing Address - Phone:703-717-4051
Mailing Address - Fax:703-717-4057
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:STE 465
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-717-4051
Practice Address - Fax:703-717-4057
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010335929174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6203167Medicaid
VA6203167Medicaid
VAD09607Medicare UPIN