MEDICARE: DR. MARLENE JOY SEVERSON M.D.

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	2085R0202X	Diagnostic Radiology Physician	0101238982	VA
2	2085R0202X	Diagnostic Radiology Physician	D0043279	MD
3	2085R0202X	Diagnostic Radiology Physician	MD037497	DC

General Provider Information

NPI Number	:	1598796179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARLENE JOY SEVERSON M.D.

Provider Business Mailing Address
First Line	:	2101 E JEFFERSON ST
Second Line	:	KAISER PERMANENTE MEDICARE ENROLLMENT
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-7405
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N WASHINGTON ST
Second Line	:	KAISER PERMANENTE MEDICAL CENTER
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-4518
Country	:	US
Telephone Number	:	703-237-4000
Fax Number	:

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/06/2012

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