Provider Demographics
NPI:1164819066
Name:JUNGWIRTH, MARINA SHUSTER (MD)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:SHUSTER
Last Name:JUNGWIRTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:SHUSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8988 LORTON STATION BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4757
Mailing Address - Country:US
Mailing Address - Phone:703-261-4961
Mailing Address - Fax:703-540-1615
Practice Address - Street 1:8988 LORTON STATION BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4757
Practice Address - Country:US
Practice Address - Phone:703-261-4961
Practice Address - Fax:703-540-1615
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10601600207N00000X
VA0101269248207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty