Basic Information
| Provider Information | |||||||||
| NPI: | 1891705588 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAR | ||||||||
| FirstName: | NATALIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100925 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303840925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014758600 | ||||||||
| FaxNumber: | 8014758686 | ||||||||
| Practice Location | |||||||||
| Address1: | 5405 S 500 E STE 202 | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844057419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014758600 | ||||||||
| FaxNumber: | 8014758686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | A71887 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 1003001553 | 05 | UT | MEDICAID |