Individual
MARK WANTAJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
96 15TH ST NW, NORTON, VA 24273-1625
(276) 679-3488
Mailing address
110 CLINTON AVE E, BIG STONE GAP, VA 24219-2924
(360) 355-4215
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0116034298
VA
207R00000X
Internal Medicine Physician
OP61432898
WA
Other
Enumeration date
06/22/2020
Last updated
07/19/2023
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