Provider Demographics
NPI:1265435523
Name:MARQUARDT, EVELINE B (MD)
Entity type:Individual
Prefix:
First Name:EVELINE
Middle Name:B
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 TOWN CENTER DR
Mailing Address - Street 2:STE 319
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3239
Mailing Address - Country:US
Mailing Address - Phone:703-668-0520
Mailing Address - Fax:703-668-0525
Practice Address - Street 1:1800 TOWN CENTER DR
Practice Address - Street 2:STE 319
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3239
Practice Address - Country:US
Practice Address - Phone:703-668-0520
Practice Address - Fax:703-668-0525
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043271207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F910OtherCAREFIRST PROVIDER NUMBER
4315160OtherAETNA PROVIDER NUMBER
503858OtherNCPPO PROVIDER NUMBER
VA259706OtherANTHEM PROVIDER NUMBER
4315160OtherAETNA PROVIDER NUMBER
E53246Medicare UPIN