Provider Demographics
NPI:1669716171
Name:MARDER, ARIMA BAASANJAV (ADMIN)
Entity type:Individual
Prefix:
First Name:ARIMA
Middle Name:BAASANJAV
Last Name:MARDER
Suffix:
Gender:F
Credentials:ADMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 FALCON NEST PL APT 205
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-0937
Mailing Address - Country:US
Mailing Address - Phone:757-593-7611
Mailing Address - Fax:757-659-0463
Practice Address - Street 1:50 VOYAGER DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5348
Practice Address - Country:US
Practice Address - Phone:757-593-7611
Practice Address - Fax:757-659-0463
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA089174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator