Provider Demographics
NPI:1194943464
Name:GODEC, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:GODEC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4431 SLEAFORD RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3925
Mailing Address - Country:US
Mailing Address - Phone:703-918-9365
Mailing Address - Fax:703-991-8800
Practice Address - Street 1:11140 ROCKVILLE PIKE
Practice Address - Street 2:#216
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3106
Practice Address - Country:US
Practice Address - Phone:703-918-9365
Practice Address - Fax:703-991-8800
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD376202084N0400X
VA01012359172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology