Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0102205363 | VA |
NPI | 1003355579 |
---|---|
Provider Name | David Christopher Mari |
First Address | Hampton, VA 23665-2040 |
Second Address | Hampton, VA 23665-2040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2017 |
Last Update Date | 06/10/2021 |