Individual
MARK C HARTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1850 TOWN CENTER PKWY, SUITE 400, RESTON, VA 20190-3219
(703) 810-5202
(703) 787-9664
Mailing address
PO BOX 75868, BALTIMORE, MD 21275-5868
(703) 383-6469
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101041921
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6402038
—
VA
01
—
DC1555
MEDICARE RAILROAD GROUP
—
01
—
P00151220
MEDICARE RAILROAD
—
Enumeration date
07/21/2006
Last updated
10/26/2020
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