Healthcare Provider Details

I. General information

NPI: 1922327196
Provider Name (Legal Business Name): MARK VICTOR SAKRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 CHAIN BRIDGE RD SUITE 203
MC LEAN VA
22101-4501
US

IV. Provider business mailing address

8601 LARKHAVEN TER
FAIRFAX STATION VA
22039-3313
US

V. Phone/Fax

Practice location:
  • Phone: 571-435-3334
  • Fax:
Mailing address:
  • Phone: 571-435-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101258452
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD79256
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: