Mark, Sam

Mark, Sam is an sole proprietor health care provider with primary practice located at 4660 Kenmore Ave Ste 608 , Alexandria VA 22304-1306. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Mark, Sam can be contacted via phone (703) 578-4161.

Contact Information

Primary practice address
4660 Kenmore Ave Ste 608 Alexandria VA 22304-1306
Phone: (703) 578-4161
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 0103301337 Virginia

Profile Details

NPI number 1770014193
LBN Legal business name Mark, Sam
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 27th, 2017
Last updated Oct 2nd, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770014193 NPPES
Virginia MEDICAID 30015750040001
Virginia MEDICAID 1770014193

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