Healthcare Provider Details

I. General information

NPI: 1841291937
Provider Name (Legal Business Name): MARK EDWARD MAVITY MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MEDICAL GROUP 238 BROOKLEY AVENUE
BOLLING AFB DC
20332-0001
US

IV. Provider business mailing address

9105 BRAMBLE PL
ANNANDALE VA
22003-4015
US

V. Phone/Fax

Practice location:
  • Phone: 202-404-5866
  • Fax:
Mailing address:
  • Phone: 703-764-1736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberMD066025L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD066025L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: