Healthcare Provider Details

I. General information

NPI: 1154309136
Provider Name (Legal Business Name): MARCIE K. WEIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 ARLINGTON BLVD SUITE 209
FAIRFAX VA
22031-2902
US

IV. Provider business mailing address

8301 ARLINGTON BLVD SUITE 209
FAIRFAX VA
22031-2902
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-9111
  • Fax: 703-698-8338
Mailing address:
  • Phone: 703-876-9111
  • Fax: 703-698-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number0101050969
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: