Individual
DR. JONATHAN RUSSELL MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 GRESHAM DR STE 1100, NORFOLK, VA 23507-1904
(757) 388-6200
Mailing address
600 GRESHAM DR STE 1100, NORFOLK, VA 23507-1904
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
0116021508
VA
207Y00000X
Otolaryngology Physician
Primary
35.124086
OH
Other
Enumeration date
04/06/2009
Last updated
02/17/2022
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