Individual
MARK C. VIVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2901 TELESTAR CT., #200, FALLS CHURCH, VA 22042-1262
(703) 573-3494
(703) 573-5353
Mailing address
2901 TELESTAR CT., #300, FALLS CHURCH, VA 22042-1263
(703) 591-1688
(703) 591-1445
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
0101236008
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035583600
—
DC
05
—
1902806714
—
VA
05
—
404953500
—
MD
01
—
P00118400
RAILROAD MEDICARE DC #
DC
01
—
P00608092
RAILROAD MEDICARE VA
VA
Enumeration date
07/22/2005
Last updated
08/27/2021
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