Provider Demographics
NPI:1194746453
Name:MARIK, PAUL E (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:MARIK
Suffix:
Gender:M
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5758
Mailing Address - Fax:757-446-7452
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5758
Practice Address - Fax:757-446-7452
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071427L207R00000X, 207RC0200X
VA0109542065207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001814953Medicaid
VAPAROtherUNITED HEALTH CARE/MAMSI
NJ0052523Medicaid
VA376526OtherANTHEM BC/BS
VAPAROtherUSA MANAGED CARE (EVMS HEALTH SERVICES)
VA-029OtherTRICARE/CHAMPUS
VA1194746453Medicaid
VAPAROtherCORVEL/CORCARE (EVMS HEALTH SERVICES)
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VAPAROtherVA PREMIER HEALTH
VAPAROtherCIGNA
VA10048909OtherSENTARA/OPTIMA HEALTH
VA376522OtherANTHEM BC/BS
NC7613023Medicaid
VAPAROtherMULTIPLAN (EVMS HEALTH SERVICES)
VAPAROtherAETNA
VAPAROtherVA HEALTH NETWORK
VA1194746453Medicaid
NJ0052523Medicaid
PA039321Medicare PIN