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1558323881

NPI Code Detail

MEDICARE: DR. LAURA J. MARK M.D.

MEDICARE: DR. LAURA J. MARK 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	2084P0800X	Psychiatry Physician	0101053093	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	O83589	OTHER	VA	SOUTHERN HEALTH
2	140026	OTHER	VA	ANTHEM
3	140026	OTHER	VA	HEALTHKEEPERS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	140027	OTHER	VA	HEALTHKEEPERS
6	15-13209	OTHER	VA	UNITED BEHAVIORAL HEALTH
7	2004239	OTHER	VA	CIGNA
8	331733	OTHER	VA	TRICARE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	406380	OTHER	VA	VALUE OPTIONS
11	7303231	OTHER	VA	AETNA
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	140027	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1558323881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA J. MARK M.D.

Provider Business Mailing Address
First Line	:	414 MAIN ST
Second Line	:
City	:	WARSAW
State	:	VA
Zip	:	22572-4291
Country	:	US
Telephone Number	:	804-693-5068
Fax Number	:	804-693-7407

Provider Business Practice Location Address
First Line	:	414 MAIN ST
Second Line	:
City	:	WARSAW
State	:	VA
Zip	:	22572-4291
Country	:	US
Telephone Number	:	804-333-3671
Fax Number	:	804-333-3657

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. LAURA J. MARK M.D.” Practice Location

Language	Start Address	Practice Location

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