Healthcare Provider Details

I. General information

NPI: 1861781544
Provider Name (Legal Business Name): MARK EVERETT ROLFS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 WARDS RD
LYNCHBURG VA
24502-2101
US

IV. Provider business mailing address

2321 WARDS RD
LYNCHBURG VA
24502-2101
US

V. Phone/Fax

Practice location:
  • Phone: 434-582-2273
  • Fax:
Mailing address:
  • Phone: 434-582-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11016270A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0102204157
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11016270A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: