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NPI Code Detail

MEDICARE: DR. MARK EDWARD MAVITY MD, MPH

MEDICARE: DR. MARK EDWARD MAVITY MD, MPH
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
12083A0100XAerospace Medicine PhysicianMD066025LPA
22083P0901XPublic Health & General Preventive Medicine PhysicianMD066025LPA

General Provider Information

NPI Number : 1841291937
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK EDWARD MAVITY MD, MPH
Provider Business Mailing Address
First Line : 9105 BRAMBLE PL
Second Line :
City : ANNANDALE
State : VA
Zip : 22003-4015
Country : US
Telephone Number : 703-764-1736
Fax Number :
Provider Business Practice Location Address
First Line : 11 MEDICAL GROUP
Second Line : 238 BROOKLEY AVENUE
City : BOLLING AFB
State : DC
Zip : 20332-0001
Country : US
Telephone Number : 202-404-5866
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 09/11/2025

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