Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0101233860 | VA |
N | 2086S0122X | Plastic and Reconstructive Surgery | D0066278 | MD |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD0334485 | DC |
NPI | 1093734717 |
---|---|
Provider Name | Mark Louis Venturi |
First Address | Mc Lean, VA 22102-2814 |
Second Address | Mc Lean, VA 22102-2814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 19/02/2009 |