Healthcare Provider Details

I. General information

NPI: 1063441533
Provider Name (Legal Business Name): MARK A LANDRIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 CEDAR CREEK GRADE SUITE 200
WINCHESTER VA
22601-2818
US

IV. Provider business mailing address

905 CEDAR CREEK GRADE SUITE 200
WINCHESTER VA
22601-2818
US

V. Phone/Fax

Practice location:
  • Phone: 540-722-8882
  • Fax: 540-722-8883
Mailing address:
  • Phone: 540-722-8882
  • Fax: 540-722-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101057597
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: