Healthcare Provider Details

I. General information

NPI: 1700073269
Provider Name (Legal Business Name): MARAGH DERMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45155 RESEARCH PL SUITE 140
ASHBURN VA
20147-4191
US

IV. Provider business mailing address

45155 RESEARCH PL SUITE 140
ASHBURN VA
20147-4191
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-0500
  • Fax: 703-858-5155
Mailing address:
  • Phone: 703-858-0500
  • Fax: 703-858-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number0101241757
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number0101241757
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0066429
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberD0066429
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberD0066429
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101241757
License Number StateVA

VIII. Authorized Official

Name: DR. SHERRY LH MARAGH
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 703-858-0500