Individual
MARK P. TANENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3580 JOSEPH SIEWICK DR STE 305, FAIRFAX, VA 22033-1764
(703) 648-3266
(703) 648-3264
Mailing address
2901 TELESTAR CT., #300, FALLS CHURCH, VA 22042-1263
(703) 591-1688
(703) 591-1445
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
0101043105
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031738500
—
DC
01
—
060035106
RAILROAD MEDICARE DC #
DC
01
—
060062627
RAILROAD MEDICARE VA #
VA
05
—
1114929247
—
VA
05
—
121300800
—
MD
Enumeration date
06/01/2005
Last updated
08/25/2022
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