Healthcare Provider Details

I. General information

NPI: 1821020579
Provider Name (Legal Business Name): ROBERT M. MORDKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N GEORGE MASON DR STE 454
ARLINGTON VA
22205-3684
US

IV. Provider business mailing address

1625 N GEORGE MASON DR STE 454
ARLINGTON VA
22205-3684
US

V. Phone/Fax

Practice location:
  • Phone: 703-717-4200
  • Fax: 703-717-4201
Mailing address:
  • Phone: 703-717-4200
  • Fax: 703-717-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101051121
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: