1629037171 NPI number — MRS. LAURIE SUSAN MARKIN MD

Table of content: MRS. LAURIE SUSAN MARKIN MD (NPI 1629037171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629037171 NPI number — MRS. LAURIE SUSAN MARKIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARKIN
Provider First Name:
LAURIE
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TELLER
Provider Other First Name:
LAURIE
Provider Other Middle Name:
SUSAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629037171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5645 STONE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTREVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20120-1618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-266-2442
Provider Business Mailing Address Fax Number:
703-266-7158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5645 STONE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTREVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20120-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-266-2442
Provider Business Practice Location Address Fax Number:
703-266-7158
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101053965 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0181539 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5615712 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80940004 . This is a "CAREFIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 502653 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 288721 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5565205 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 383307 . This is a "BCBS ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 746938 . This is a "ONE HEALTH PLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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