Healthcare Provider Details

I. General information

NPI: 1972500650
Provider Name (Legal Business Name): MARK JERROLD SCHEFKIND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 HINSON FARM RD SUITE 103
ALEXANDRIA VA
22306-3403
US

IV. Provider business mailing address

8101 HINSON FARM RD SUITE 103
ALEXANDRIA VA
22306-3403
US

V. Phone/Fax

Practice location:
  • Phone: 703-360-0111
  • Fax: 703-799-1126
Mailing address:
  • Phone: 703-360-0111
  • Fax: 703-799-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101043631
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: