Healthcare Provider Details

I. General information

NPI: 1609817253
Provider Name (Legal Business Name): MARSHALL A SCHORIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HAMAKER CT SUITE #202
FAIRFAX VA
22031-2238
US

IV. Provider business mailing address

3020 HAMAKER CT SUITE #202
FAIRFAX VA
22031-2238
US

V. Phone/Fax

Practice location:
  • Phone: 571-226-5600
  • Fax: 571-423-5064
Mailing address:
  • Phone: 571-226-5600
  • Fax: 571-423-5064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD.06094R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: