Healthcare Provider Details

I. General information

NPI: 1740444181
Provider Name (Legal Business Name): MEHRAK MICHAEL MARZBAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 OLD MEADOW RD STE 410
MC LEAN VA
22102-4324
US

IV. Provider business mailing address

1749 OLD MEADOW RD STE 410
MC LEAN VA
22102-4324
US

V. Phone/Fax

Practice location:
  • Phone: 703-651-3775
  • Fax: 703-651-3775
Mailing address:
  • Phone: 703-651-3775
  • Fax: 703-651-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0074318
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101272891
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: