Individual
SAM MARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
4660 KENMORE AVE STE 608, ALEXANDRIA, VA 22304-1306
(703) 578-4161
Mailing address
224D CORNWALL ST NW STE 403, LEESBURG, VA 20176-2704
(703) 737-6001
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0103301337
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770014193
—
VA
05
—
30015750040001
—
VA
Enumeration date
03/27/2017
Last updated
10/02/2023
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