Provider Demographics
NPI:1811153000
Name:ROLLINS-RAVAL, MARIAN ALICE (MD MPH)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:ALICE
Last Name:ROLLINS-RAVAL
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:ALICE
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PATHOLOGY MSC08 4640
Practice Address - Street 2:FITZ HALL, ROOM 335 1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-272-4814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2018-0750207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology