Provider Demographics
NPI:1366407157
Name:MARAGH, SHERRY LYNETTE HENDERSON (MD)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:LYNETTE HENDERSON
Last Name:MARAGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHERRY
Other - Middle Name:LYNETTE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241757207N00000X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA4414Medicare ID - Type Unspecified
H41101Medicare UPIN