Provider Demographics
NPI:1720057391
Name:MARAGH, HALLENE A (MD)
Entity Type:Individual
Prefix:
First Name:HALLENE
Middle Name:A
Last Name:MARAGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 GROVE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4308
Mailing Address - Country:US
Mailing Address - Phone:804-257-7195
Mailing Address - Fax:804-254-5314
Practice Address - Street 1:2621 GROVE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4308
Practice Address - Country:US
Practice Address - Phone:804-257-7195
Practice Address - Fax:804-254-5314
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010403872086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1538128483OtherGROUP NPI
B06648Medicare UPIN
VAGC1196Medicare PIN
240000257Medicare ID - Type Unspecified