Provider Demographics
NPI:1750766473
Name:TURK, MARIE LYSE (MD)
Entity type:Individual
Prefix:
First Name:MARIE LYSE
Middle Name:
Last Name:TURK
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:BOX 800623
Mailing Address - Street 2:1215 LEE ST.
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908
Mailing Address - Country:US
Mailing Address - Phone:434-243-4646
Mailing Address - Fax:434-243-4743
Practice Address - Street 1:1 BMC PLACE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02134
Practice Address - Country:US
Practice Address - Phone:434-243-4646
Practice Address - Fax:617-638-8670
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116028131390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program