MEDICARE: DR. MARK A LANDRIO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	0101057597	VA

General Provider Information

NPI Number	:	1063441533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A LANDRIO M.D.

Provider Business Mailing Address
First Line	:	905 CEDAR CREEK GRADE
Second Line	:	SUITE 200
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2818
Country	:	US
Telephone Number	:	540-722-8882
Fax Number	:	540-722-8883

Provider Business Practice Location Address
First Line	:	905 CEDAR CREEK GRADE
Second Line	:	SUITE 200
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2818
Country	:	US
Telephone Number	:	540-722-8882
Fax Number	:	540-722-8883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	04/10/2008

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