MEDICARE: DR. MARK VICTOR SAKRAN 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	2084P0804X	Child & Adolescent Psychiatry Physician	0101258452	VA
2	2084P0804X	Child & Adolescent Psychiatry Physician	D79256	MD

General Provider Information

NPI Number	:	1922327196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK VICTOR SAKRAN M.D.

Provider Business Mailing Address
First Line	:	8601 LARKHAVEN TER
Second Line	:
City	:	FAIRFAX STATION
State	:	VA
Zip	:	22039-3313
Country	:	US
Telephone Number	:	571-435-3334
Fax Number	:

Provider Business Practice Location Address
First Line	:	1485 CHAIN BRIDGE RD
Second Line	:	SUITE 203
City	:	MC LEAN
State	:	VA
Zip	:	22101-4501
Country	:	US
Telephone Number	:	571-435-3334
Fax Number	:

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

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	04/26/2017

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