Provider Demographics
NPI:1124117015
Name:CHILDRESS, MARC A (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:CHILDRESS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12011 LEE JACKSON MEMORIAL HIGHWAY
Mailing Address - Street 2:SUITE 504
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3315
Mailing Address - Country:US
Mailing Address - Phone:703-391-2070
Mailing Address - Fax:703-273-3943
Practice Address - Street 1:3650 JOSEPH SIEWICK DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-391-2020
Practice Address - Fax:703-391-1211
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
IN01059898A207Q00000X
VA0101252825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine