Healthcare Provider Details

I. General information

NPI: 1710106067
Provider Name (Legal Business Name): MARK JOSEPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CRYSTAL SPRING AVE SW SUITE 201
ROANOKE VA
24014-2462
US

IV. Provider business mailing address

2001 CRYSTAL SPRING AVE SW SUITE 201
ROANOKE VA
24014-2462
US

V. Phone/Fax

Practice location:
  • Phone: 540-853-0100
  • Fax: 540-342-9308
Mailing address:
  • Phone: 540-853-0100
  • Fax: 540-342-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number0101-256570
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101-256570
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101-256570
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: