Healthcare Provider Details

I. General information

NPI: 1518977263
Provider Name (Legal Business Name): VESNA MRZLJAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 STEVENSON AVE UNIT A
ALEXANDRIA VA
22304-3576
US

IV. Provider business mailing address

6300 STEVENSON AVE UNIT A
ALEXANDRIA VA
22304-3576
US

V. Phone/Fax

Practice location:
  • Phone: 703-751-6060
  • Fax: 703-751-6870
Mailing address:
  • Phone: 703-751-6060
  • Fax: 703-751-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101035385
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number0101035385
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: