Provider Demographics
NPI:1700073269
Name:MARAGH DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:MARAGH DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LH
Authorized Official - Last Name:MARAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-858-0500
Mailing Address - Street 1:45155 RESEARCH PL
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4191
Mailing Address - Country:US
Mailing Address - Phone:703-858-0500
Mailing Address - Fax:703-858-5155
Practice Address - Street 1:45155 RESEARCH PL
Practice Address - Street 2:SUITE 140
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4191
Practice Address - Country:US
Practice Address - Phone:703-858-0500
Practice Address - Fax:703-858-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241757207NS0135X, 207ND0101X, 207N00000X
MDD0066429207N00000X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H41101Medicare UPIN
C10357Medicare PIN