MEDICARE: MARY ARRIETA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101036597	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083695209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ARRIETA MD

Provider Business Mailing Address
First Line	:	34 MEDICAL PARK BLVD STE F
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9283
Country	:	US
Telephone Number	:	804-520-8135
Fax Number	:	804-520-8092

Provider Business Practice Location Address
First Line	:	34 MEDICAL PARK BLVD STE F
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9283
Country	:	US
Telephone Number	:	804-520-8135
Fax Number	:	804-520-8092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	04/02/2013

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Directions to “ MARY ARRIETA MD” Practice Location

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