Individual
MARK A PAVILACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3235 ACADEMY AVE, SUITE 200, PORTSMOUTH, VA 23703-3200
(757) 483-0400
Mailing address
3235 ACADEMY AVE, SUITE 200, PORTSMOUTH, VA 23703-3200
(757) 483-0400
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101232985
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245238096
—
VA
01
—
247538
ANTHEM
VA
05
—
6309909
—
VA
Enumeration date
07/13/2005
Last updated
04/30/2013
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