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General NPI Number Information
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NPI Number | 1770716656
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Entity Type | Organization
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Legal Business Name | MARK M. THEISS, MD, P.C.
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 8316 ARLINGTON BLVD SUITE 414
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City | FAIRFAX
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State | VA
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Zip | 22031-5207
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Country | US
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Telephone | 703-573-2218
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Fax | 703-573-2373
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Provider Business Mailing Address
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Address Line | 8316 ARLINGTON BLVD SUITE 414
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City | FAIRFAX
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State | VA
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Zip | 22031-5207
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Country | US
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Telephone | 703-573-2218
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Fax | 703-573-2373
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AUDREY CARR
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Credential |
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Telephone | 703-573-2218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101036798
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License Number State | VA
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