Individual
MARK A GENTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
13700 ST FRANCIS BLVD, SUITE 505, MIDLOTHIAN, VA 23114-3222
(804) 601-0609
(804) 594-7424
Mailing address
PO BOX 73262, NORTH CHESTERFIELD, VA 23235-8029
(804) 601-0609
(804) 594-7424
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
0102201823
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0102201823
—
VA
01
—
C11046
GROUP MEDICARE PTAN
VA
Enumeration date
06/15/2006
Last updated
01/11/2017
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