MEDICARE: GEORGE EDWARD MARAK M.D.

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	207W00000X	Ophthalmology Physician	0101021243	VA

General Provider Information

NPI Number	:	1689811531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE EDWARD MARAK M.D.

Provider Business Mailing Address
First Line	:	6320 FORT HUNT RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-1343
Country	:	US
Telephone Number	:	703-329-1683
Fax Number	:	703-329-1683

Provider Business Practice Location Address
First Line	:	6320 FORT HUNT RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-1343
Country	:	US
Telephone Number	:	703-329-1683
Fax Number	:	703-329-1683

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

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	01/14/2009

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