Healthcare Provider Details

I. General information

NPI: 1104746031
Provider Name (Legal Business Name): MARK P. FLETCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PANTOPS MOUNTAIN RD APT 15
CHARLOTTESVILLE VA
22911-8600
US

IV. Provider business mailing address

250 PANTOPS MOUNTAIN RD APT 15
CHARLOTTESVILLE VA
22911-8600
US

V. Phone/Fax

Practice location:
  • Phone: 203-803-7923
  • Fax:
Mailing address:
  • Phone: 203-803-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberG34861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: