Healthcare Provider Details

I. General information

NPI: 1932119690
Provider Name (Legal Business Name): MARLON R MARAGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 06/05/2012
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:
Mailing address:
  • Phone: 703-858-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD66674
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101242333
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: