MEDICARE: DR. VLADIMIR MARKOVIC 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	208D00000X	General Practice Physician	0101256281	VA

General Provider Information

NPI Number	:	1710266796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VLADIMIR MARKOVIC M.D.

Provider Business Mailing Address
First Line	:	664 LINCOLN ST
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-4818
Country	:	US
Telephone Number	:	757-533-9108
Fax Number	:	757-622-6381

Provider Business Practice Location Address
First Line	:	3415 GRANBY ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-1421
Country	:	US
Telephone Number	:	757-533-9108
Fax Number	:	757-622-6381

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

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	09/20/2018

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