Healthcare Provider Details

I. General information

NPI: 1689719858
Provider Name (Legal Business Name): MARC NMN VATIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8218 WISCONSIN AVE 311
BETHESDA MD
20814-3107
US

IV. Provider business mailing address

8218 WISCONSIN AVE 311
BETHESDA MD
20814-3107
US

V. Phone/Fax

Practice location:
  • Phone: 301-951-1050
  • Fax: 301-718-2563
Mailing address:
  • Phone: 301-951-1050
  • Fax: 301-718-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number23135
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: