MEDICARE: DR. MARK RODNEY KING D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	0102050164	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346232014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK RODNEY KING D.O.

Provider Business Mailing Address
First Line	:	PO BOX 22245
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-9224
Country	:	US
Telephone Number	:	703-212-4770
Fax Number	:	703-212-4877

Provider Business Practice Location Address
First Line	:	2867 DUKE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4512
Country	:	US
Telephone Number	:	703-212-4770
Fax Number	:	703-212-4877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	01/05/2010

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Directions to “ DR. MARK RODNEY KING D.O.” Practice Location

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