Provider Demographics
NPI:1063441533
Name:LANDRIO, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LANDRIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:905 CEDAR CREEK GRADE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2818
Mailing Address - Country:US
Mailing Address - Phone:540-722-8882
Mailing Address - Fax:540-722-8883
Practice Address - Street 1:905 CEDAR CREEK GRADE
Practice Address - Street 2:SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2818
Practice Address - Country:US
Practice Address - Phone:540-722-8882
Practice Address - Fax:540-722-8883
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010575972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X073N01Medicare PIN
P00342128Medicare PIN
G69092Medicare UPIN